Angels Of Death: The Doctors

The Nazi Doctors

Children were fond of him, and he brought them sweets and even gave them rides to the place where they were to be exterminated. Joseph Mengele, the doctor of Auschwitz and ultimate Angel of Death, was an anomaly.

A leader in the Nazi biomedical vision, he thrived on experiments with genetic abnormalities. Even surpassing Hitler at times, Mengele has come to embody the archetype of Absolute Evil, perhaps because he so egregiously violated his professional oath to honor and preserve life.

Mengele arrived in Auschwitz on May 30, 1943. He was 32, from a Catholic family, and had long been a Nazi enthusiast. In school, his specialty had been physical anthropology and genetics, and he was fully committed to bringing science into the service of the Nazi enterprise. In fact, he specifically asked to be sent to Auschwitz because of opportunities such a place could provide for his research.

In charge of the "selections" process, he'd show up at the prisoner transports looking quite elegant, and would decide at a glance each person's destiny. If anyone started trouble over being separated from a relative, he might wordlessly beat or shoot them both. He appeared to have no conscience, and sent anyone with an imperfection (including imperfect height) right to the gas chamber. However, he kept the twins, as many sets of doubles as he could find. They were destined for his labs.

Mengele enjoyed his powerful position and was completely at home with his tasks. To uphold the Nazi ideal of racial purification was his driving motivation. Yet no one quite knew what to expect. Even as he separated families and killed with impunity, he might step into the role of concerned physician and whimsically allow some people to live. The power of life and death resided in him.

In his desire to improve the efficiency of the camp as a killing machine, he taught other doctors how to give phenol injections to a long line of prisoners, quickly ending their lives. He also shot people, and by some reports he tossed live babies into the crematoria. Throughout all of this, he kept a detached, efficient demeanor and viewed himself as strictly a scientist.

Mengele's great passion was his research on twins. They were weighed, measured, and compared in every way. Blood was endlessly withdrawn and they were questioned about their family histories. Some he would kill for pathological examinations, dissecting a few himself and keeping a few parts preserved. Others he might operate on without anesthesia, removing limbs or sexual organs. He even did some sex-change operations. If one twin died during these experiments, the other was no longer of use, so he or she was simply gassed.

Substances were injected into living children to see how they reacted, often damaging or killing them. It didn't matter much to Mengele; there were always more on the way. Yet even as he targeted them for mutilation or death, he'd play with them and show great affection. Afterward, he might walk around with their heads or pin their eyes to a bulletin board.

He also studied dwarves and particular types of mutilating diseases, but one odd experiment was his attempt to change eye color to blue. He'd inject the eyes of children with a chemical that caused immense pain and even blindness, but which failed to have the desired effect. Those who worked with him thought him scientifically irresponsible and naive.

Overall, Mengele was caught up with the idea of genetic cultivation of a superior race, and his esteemed position there at the camp fed his desire to be a god. He kept notes on all of his procedures to send to his mentor, but most of these were lost. After the war, Mengele escaped the Nuremburg trials and fled to South America. He died in 1979 and his remains were identified by a team of forensic anthropologists. Even so, his evil lives on in the fictions and fantasies of a cruel doctor who killed without conscience and was responsible for the destruction of many thousands of innocent people.

While some doctors go into the profession precisely for power over life and death, that anyone in the healing profession would so indifferently inflict pain and destruction on those in his care is rather jarring. Unfortunately, doctors who harm are difficult to detect and stop. Some are careful, having vulnerable victims easily within reach, and others are actually protected by the medical establishment. Let's look at a recent case where an obvious sociopath got away with killing because no one bothered to listen to those who complained. In some respects, Dr. Michael Swango practiced his fiendish experiments like a contemporary Mengele.

Swango, The Experimenter

Ruth Barrick was a neurosurgery patient. She'd hit her head and nearly died, but was doing well there at the Ohio State University Medical Center. Dr. Michael Swango, an intern, told a nurse that he was going to check on her. The nurse thought this was strange, and when she later checked on Barrick herself, she found the woman barely breathing. Calling a code, she and the medical team managed to stabilize Barrick's vital signs and she recovered.

Then a few days later, Swango went into Barrick's room again. Another nurse checked on him several times and spotted several syringes. After nearly half an hour with the patient, Swango left, and when the nurse went in to see Barrick, she found the woman once again in a very bad state. While she administered mouth-to-mouth resuscitation, she heard Dr. Swango come in and say, "That is so disgusting."

Yet her efforts were useless. Ruth Barrick was dead and the nurse suspected that Swango had done something to cause it.

In fact, before he disappeared from the place, five patients died and several grew terribly ill. He'd also given a "spicy" chicken dinner to several coworkers, all of whom had become ill afterward. Swango was clearly a menace.

Even so, throughout his medical career, people had covered for Swango, and the same thing would happen again and again: He was allowed to get away with murder. His fellow students knew that he was unfit for a medical career---was in fact downright weird. They called him "Double-O Swango" because where medical care was concerned, he seemed to have a black thumb. What they didn't realize was that he truly had a license to kill. It seemed he'd entered the medical profession precisely as a cover for what he wanted to do to people. He had no compassion and he certainly had some bizarre ideas on what it meant to be a doctor. Yet this athletic, blue-eyed blonde always managed to charm his superiors into believing in him. Despite a lackluster performance, he always managed to pass through the system.

It wasn't just the medical establishment, either. Even his mother seemed to look the other way when he expressed an intense interest in violent deaths. She'd clip newspaper articles for him, assuring herself and everyone who commented on the oddity of this interest that the "information" would further Michael's medical career. He was learning things.

No doubt that's true, but what he was learning to do was bring about the deaths of other people. He found it exciting to walk out of the ER to inform worried parents of the death of their child, or to rush to an accident scene were bodies were twisted and torn apart. He lived for this kind of high.

In retrospect, it's difficult to understand how he managed to even become a doctor, let alone practice for almost two decades.

In 1983, Swango graduated from Southern Illinois School of Medicine in Springfield, Illinois, although he was a year behind his classmates for failure to complete his assignments. He served his internship at Ohio State University, but when his post was finished, it was not extended---partly because of suspicions that no one seemed to want to address. After he left, the authorities began to investigate him for murder, but found insufficient evidence to charge him with anything. It's not easy to pin a murder on someone giving injections to patients when that's what doctors do.

Swango then started work with a team of paramedics, who seemed to get along with him. Feeling comfortable, he told them his ultimate fantasy: "It's like this," he said. "Picture a school bus crammed with kids smashing head-on with a trailer truck loaded down with gasoline. We're summoned. We get there in a jiffy just as another gasoline truck rams the bus. Up in flames it goes! Kids are hurled through the air, everywhere, on telephone poles, on the street, especially along an old barbed wire fence along the road. All burning."

The others were put off. This guy was sick. They kept their distance.

Then one day Swango brought in a box of doughnuts, and four of his fellow workers who partook of it got severely ill. Another time, he offered soft drinks to two others, who also got sick. They quickly caught on to what he was doing and laid a trap. It soon became clear that Swango was poisoning them. He shrugged off their concerns, yet there was sufficient evidence from the amount of poison found in his locker and home to convict him of six counts of aggravated battery, for which he did less than three years in prison.

Despite that, he was accepted into several more positions in Virginia, South Dakota, New York, and Zimbabwe. All he had to do was lie, fake his credentials, adopt aliases, and misrepresent his past employment history. No one checked, and wherever he went, colleagues became ill and patients died. Each time authorities closed in, he was gone.

When Swango was finally stopped by the FBI, he'd been on a roll for almost two decades in seven different hospitals. In many cases, someone had seen him with a syringe, and several patients who recovered indicated that it was the blond doctor who had injected them before they lost the ability to feel and move.

In 1998, he was charged with killing five patients in a hospital in Zimbabwe, where he had worked from 1994-1996. However, complications with extraditing him to Africa meant that he would not be prosecuted. Then the FBI looked into his history, and agents estimated that he may have been responsible for directly causing well over thirty deaths. Apparently he just liked to see what would happen when he did this or that to a human being, whether patient or colleague.

James Stewart, who wrote Blind Eye after spending two years documenting Swango's swath of death, called him a psychopath who would never stop. "If he is free," Stewart said, "he will find a means and a place to do it again."

Arraigned on July 17, 2000, he finally confessed in September. He pleaded guilty to fatally poisoning three patients in 1993 at a New York hospital, and was convicted of another murder in Ohio. In a plea deal, he was sentenced to life in prison without the possibility of parole. The extent of his evil likely surpasses his admissions and may never be known.

Swango is not alone in this type of infamy. Throughout history there have been doctors who killed, and the list of motives is long and complex. Let's have a look at the most common ones.

Motives: Part 1

Killers in the medical profession seem especially heinous because while they take an oath to do everything in their power to keep someone alive, they tend to see their patients as guinea pigs. Their motive for becoming doctors seems to be more about power, control, and gain than about healing and helping. Victims are readily available and it's not that difficult to cover up certain types of murders in a major hospital, especially if the patients are elderly or have a serious illness. What's one more injection?

While nurses tend to be mercy killers, that's been true of few doctors. Some of the more mundane motives include:

Heroism: They find a way to turn a medical case into a dramatic emergency in which they play the lead role. Even if the person dies, they appeared to try as hard as they could to be the rescuer, which wins accolades from colleagues and staff.

Misplaced compassion: Dr. John Bodkins Adams was charged with 21 counts of murder in 1957 when it was found that some forty of his elderly female patients had died under mysterious circumstances. While Adams was acquitted, it was clear that he had built up severe dependency in his patients of morphine or barbiturates as a way to "ease" the passage. He did not consider this to be murder.

To cover up another crime: While it hasn't been proved that he actually molested them, oral surgeon Tony Protopappas fatally overdosed three young female patients, and all of them were attractive. Dr. Marcel Petiot, who was executed for murdering twenty-four people (though he claimed it was sixty-three), apparently did away with a girl in his employ who got pregnant. He also murdered wealthy Jewish patients in the 1940s with strychnine to get away with stealing their worldly goods.

Murder by tacit consent: During the eighteenth and nineteenth centuries, the medical establishment needed corpses to train students. It became a practice to rob fresh graves, and eventually when that activity became difficult, some people supplied the freshest of bodies by simply killing them. One such person was William Burke. Together with his partner William Hare, he would get his victims drunk and then either grab them from behind in an arm lock around the throat or sit on their chests while holding their nose and mouth closed. In nine months, these two managed to kill 16 people and then sold them one after another to the medical school in Edinburgh, Scotland, for an average of ten pounds. While physician Robert Knox noticed how fresh the corpses were and that they obviously had not been buried, he didn't ask questions. He just paid for the bodies. By doing so, he participated in murder---and got away with it.

Domestic issues: Harvey Hawley Crippen killed his wife in England in 1910, in part to escape her domineering ways and in part because he was in love with his young secretary. One night he poisoned Belle, shot her in the head, dismembered her, and buried her parts in his cellar (or tossed some into the canal.) He told her friends that she had left him to join a lover in America, but a Scotland Yard inspector didn't buy it. He questioned the dentist, who subsequently fled, leaving his house available to the detective's search. Bell's parts were found and Crippen was caught, tried, and hanged.

Another case of domestic motives was Dr. Sam Sheppard, which dominated the news at various times from the 1950's, when the murder of his wife Marilyn occurred in the Cleveland area, to a couple of years ago. Handsome, athletic, and philandering Dr. Sheppard claimed that a bushy-haired intruder broke into his home, bludgeoned his pregnant wife to death and knocked him unconscious in two separate incidences, all without waking his young son and the family dog in a nearby bedroom. Police, judge and jury did not believe his incredible story and Sheppard went to prison. Given the prejudicial newspaper coverage at his trial, super lawyer F. Lee Bailey won Sheppard a second trial after which the doctor was acquitted. A sympathetic television series and movie called The Fugitive gave Dr. Sheppard an additional publicity boost. In the late 1990's, his son attempted to have the State of Ohio declare his late father innocent using the latest DNA techniques, but was unsuccessful. Many of the people involved in the original murder investigation, as well as many people in the Cleveland area where the murder occurred, believe that Sheppard was very guilty of murdering his wife so that he could then marry his girlfriend.

Motives: Part 2

Certain doctors actually exploit their position for the express purpose of murder, such as those who kill for the following reasons:

Experimentation: People become doctors because they're innately curious about the human body and the only way to experiment with it without being discovered is to kill the victims. H. H. Holmes is a good example, and if Jack the Ripper was a physician, as some suspect, this may have motivated him, too. Obviously, Joseph Mengele had this motive, although he did not have to find ways to cover it up. He was free to experiment all he wanted on creatures that were considered less than human.

Financial profit: Some doctors participate in schemes to defraud insurance companies by killing people and sharing in the death benefits. Dr. Morris Bolber organized a partnership for this type of crime in Philadelphia in the 1930s. It is estimated that he and his partners killed around fifty people before they were stopped.

Bloodlust: For some, committing a violent death is as exciting as a sexual encounter. They want the heightened feeling that comes from the excitement that results from killing or watching others react to a death. Michael Swango, for example, described a major fatal accident as an ultimate fantasy and also admitted how much he loved coming out of the ER with an erection, knowing he was about to tell parents that their child is dead.

Dr. Francis E. Sweeney was the prime suspect and man who super cop Eliot Ness believed was guilty in a series of thirteen Depression-era murders in Cleveland. Still officially unsolved, the killer was believed to have medical knowledge and, almost uniquely in serial killer history, killed men and women equally by expert decapitation. Sweeney, a brilliant but twisted surgeon, taunted Ness for years about not having sufficient evidence to convict him.

Visionary purposes: Mengele believed that his experiments with people were a way to put science into the service of the Nazi goal of evolving a superior human race. He had a mission to kill.

Punishment and power: Dr. Thomas Neill Cream poisoned four women in part for sadistic pleasure and in part to be their judge and executioner for their immoral behavior. Going to medical school in Canada, he was forced to marry a woman he'd aborted, so he left for England. Then he returned to Canada and that's where he killed a chambermaid who came to him for an abortion. He moved to Chicago where another woman fell victim to his abortion methods. He then killed a man while "treating" his epilepsy because he coveted the man's wife. For that he went to prison for ten years. (Although he claimed as he was hung years later that he was Jack the Ripper, he was in fact behind bars in 1888.) Going to London in 1891, he poisoned four prostitutes with strychnine. Identified and arrested, he was hanged in 1892.

Relief for inner conflicts: Dr. Harold Shipman was convicted in England of 15 counts of murder in 2001. In court, he displayed indifference to the suffering he'd caused many families and contempt for the prosecution, which is indicative of sociopathy. However, according to Dr. Chris Missen, head of forensic psychology at Anglia Polytechnic University, Shipman actually had a secret self that was awash in monumental self-pity. He had watched his mother die when he was seventeen, which he may have interpreted as rejection and abandonment. He wanted the jury to believe that he had an impulse control problem, but in truth, he had been highly organized in the way he altered medical records and adopted the pretense of making proper arrangements. He'd even typed up a will for his last victim and forged her signature. "What might have been perceived as a deep inner hypersensitivity," says Missen, "may have been no more than a swollen ego, in danger of imploding at the least pinprick." Shipman could not handle potential rejection from women the age his mother would have been had she lived, so his older female patients brought out his inner conflicts. That means that what may have become suicidal despair in others turned into a homicidal rage in Shipman. He killed patients to keep from killing himself. If the estimates that his victims number nearly 300 are correct, then he killed an average of one patient a month since his medical career began.

The question can be asked whether it's the position of power that shapes them into killers or whether they're just sociopaths who managed to become doctors. A close look at one of the most flagrant offenders in American history may offer some clues.

America's Arch Fiend

In 1886, Robert Louis Stevenson published a gothic tale called The Strange Case of Dr. Jekyll and Mr. Hyde. Less than a decade later, the public would discover just how frighteningly real such a case could be.

Dr. Holmes liked to swindle insurance companies. Murder for profit was his game, but he also grew to relish his little hobby so much that he began to include torture and other types of experiments prior to death.

His real name was Herman Webster Mudgett, born in New Hampshire in 1860, and he got into the murder business around the same time as Jack the Ripper. While he confessed in 1896, it's not clear how many people he actually killed or whether he told the truth about anything. What is clear is that he did kill men, women, and children, and gave little thought to what he was doing. Had he not been caught, he'd likely have continued to con and kill for the rest of his life.

Even as an adolescent, surgery fascinated him. He'd catch animals and perform anatomical experiments on them. When he was 18, he went to medical school at the University of Michigan in Ann Arbor, graduating at the age of 24. While there, he stole corpses to practice more interesting experiments than the animals had afforded him. He also learned how to use the corpses to defraud life insurance companies, by using acid to obliterate their features and then giving them the fictitious names on the insurance policies that he'd already taken out. He was banned from the place after getting caught with a female corpse, so he moved on to Englewood, Illinois, a suburb of Chicago.

There he abandoned his first wife and took on the alias by which he would become renowned: Henry Howard Holmes. He secured a position as a druggist, and it wasn't long before the owner of the business, a widow, disappeared. Holmes used the business to sell fake cures and soon became wealthy. Though not divorced, he married again, although this wife left him after only a year.

Then Holmes built his castle. It was a huge, three-story hotel-like construction that included soundproof sleeping chambers with peepholes, asbestos-padded walls, gas pipes, sliding walls, and vents that Holmes controlled from his bedroom. The sleeping chambers also locked from the outside. The building had secret passages, hallways that went in circles, false floors, rooms with torture equipment (such as a device that stretched people to twice their height), and a specially equipped surgery. There were also greased chutes that emptied into a cellar, and a very large stove in the office.

Into this castle Holmes lured young women to seduce and drug them. Then he placed them into chambers into which he pumped lethal gases. Sometimes he'd ignite the gas and incinerate his victims. He'd watch them react and when they died, he'd slide them down the chutes into his cellar, where vats of acid and other chemicals awaited them. He'd cut up their corpses on a dissecting table and them dump them into the vats, but keep some of the organs. Then he'd sell the bleached skeletons to medical schools.

One of his victims was a woman who'd become pregnant by him. Botching her abortion, he killed her and then poisoned her teenage daughter. Other victims were people who'd rented rooms from him in order to attend the nearby 1893 World's Fair.

Holmes then married a third time and hired a lackey, Herman Pitezel. In fact, Pitezel got into the act by taking out a life insurance policy on himself and planning a way to "disappear." He and Holmes planned to find a suitable corpse to perpetuate the fraud and then split the proceeds. Pitezel should have known what was in store. Holmes was a greedy con artist who wanted all of the money for himself.

But eventually he made a mistake, which put him on the run. To get money, he killed two sisters from Texas and set fire to their house to try to claim the insurance money. (Another version says that he set fire to part of the castle to get insurance money.) Whichever is the case, it prompted an investigation, which scared Holmes sufficiently for him to leave Chicago.

He went right to Texas and started swindling people out of thousands of dollars. Then he stole a horse and the police went after him, catching him in Missouri. He skipped bail and went after Pitezel, who awaited him in Philadelphia. Holmes smothered his accomplice with chloroform and then burned him alive with acid to collect $10,000. Then he persuaded Pitezel's wife and family to escape with him, convincing them that the corpse the authorities had found was not Pitezel. He eventually killed three of the five children, burning the boy in a stove in a rented home and burying the girls in the cellar of yet another place.

Finally, the police grabbed him in Massachusetts and charged him with murder. On the way back to Philadelphia, Holmes bragged endlessly about his criminal career. Some of his alleged schemes seemed wildly improbable, but he did admit that he'd done enough in his life to be hanged twelve times over. He claimed to have the ability to hypnotize people to do whatever he wanted, and when the press got hold of this story, they attributed supernatural powers to the wretched physician. He became known as Bluebeard and even the creature from the recently published Dracula.

While in custody, over fifty people came to the police station to claim that Holmes had victimized them in some kind of con. After locating the bodies of the Pitezel children, investigators soon discovered several complete skeletons and numerous bone fragments in the Chicago castle, but Holmes insisted that he had nothing to do with them. Those people had either taken their own lives, he claimed, or been killed by someone else. He also said he did not kill Pitezel because the despairing man had committed suicide. Even so, a story of grave robbing and a beheaded corpse was traced to Holmes via his own strange tales. It was beginning to look as if his earlier confession might have contained more truth than the police realized, and it soon became clear that Holmes had killed more people than anyone had initially suspected.

In short order, the castle was taken over and remodeled as "Holmes's Horror Castle," to be exhibited as a tourist attraction, but before it opened, it burned to the ground. The police suspected some accomplice of Holmes had done it.

While in prison, Holmes wrote a book to explain how he was innocent of all the charges, but it had little effect on the outcome of his trial. It was so self-serving that no one took it seriously, and there were other more lurid tales about his crimes that made for better reading.

Holmes tried to defend himself at his trial, but was woefully inadequate. On November 4, 1895, he was convicted of the first-degree murder of Herman Pitezel.

Finally, inspired by a considerable payment from the Hearst newspaper syndicate, Holmes wrote out a long confession for The Philadelphia Inquirer, insisting that he was born to be a murderer. It was his aim to become the most notorious murderer in the world, a killer of monstrous proportions, so he said that he'd killed over one hundred people. Having second thoughts, he brought that number down to 27, and did include Pitezel. Giving the public what they wanted in terms of gruesome details on killing and corpses, Holmes claims that he couldn't help but do what he'd done.

"I was born with the Evil One as my sponsor beside the bed where I was ushered into the world," he lamented. Indeed, he believed that his face was taking an elongated shape of the devil himself, yet he felt no remorse for anything he had done.

Then in one quick move, he recanted the confession, and in fact it turned out that several of his "victims" were not dead at all. Yet so many people who'd rented rooms from him had gone missing that estimates of his true victims reached around 200, although it might have been closer to about fifty.

On May 7, 1896, Holmes was taken to the hangman's noose, and even there he changed his story. He claimed to have killed only two women, and in the middle of a sentence, the trapdoor opened and he was hung.

Because he feared grave robbers---especially physicians who wanted to study his brain---he asked that his body be buried deep and covered entirely with cement. The grave was dug ten feet down and the coffin was so heavy that it tumbled into the hole upside down. That's how it remained.

While Holmes is almost larger than life in his deadly deeds, another physician has brought the anomaly of the killing healer into sharper focus. Rather than target patients, he slaughtered his entire family.

How Doctors Can Kill

Since the motives for murder by a medical professional are all over the map, it's instructive to narrow down the types of killers to serial killers who happen to be doctors and doctors who kill repeatedly for gain or power. Situational murders, such as killing one's wife, are generally easy to explain, as are mercy killings. Doctors who kill over and over, or who kill in some utterly brutal manner, are more difficult to understand.

According to Lawrence Miller, a police psychologist in West Palm Beach, Florida, there's a neurological facet to predatory killing that is linked to the typical hunting behavior of males. While serial killers tend to act out of some intense fantasy, their hunger for violence is on the extreme end of a continuum linked to the stalking and predation that characterize many normal social activities of human life, such as hunting, romantic pursuit, entrepreneurial enterprises, and group combat.

"It is pathological," says Miller, "only in terms of degree, not the nature of the act." In other words, it's not a brain disease that sets them apart in kind. They act out, feel empowered, and continue to want that energy, just as males in battle want the thrill of victory. Some feel better after a murder, others feel better during it.

From the idea that such behavior is on a continuum with normal human behaviors arise theories like that from Robert Jay Lifton. To participate in evil, doctors must possess the psychological mechanism that allows it. He proposes the notion of "doubling" as an explanation for the Nazi doctors, and then generalizes this as a possibility for any other medical practitioner. There's a prior self---the original person before doubling takes place---and the doubled self---the one that emerges from some dark place.

Lifton calls doubling the "Faustian bargain," because one sacrifices something of oneself to gain something one thinks one needs. Doubling is "the division of the self into two functioning wholes, so that a part-self acts as an entire self."

This is not to be confused with a dissociative identity disorder in which the person has two functional personalities, nor a schizoid type of psychosis. Doubling is in fact an adaptive mechanism in the human psyche that under certain conditions helps us to survive, but it can also be stretched too far. The doctor that doubles in order to kill learns to use his ability to adapt as a way to form a self-structure that encompasses all of his behaviors. That is, he can redistribute his sense of morality to accommodate his killing by having one part of himself disavow the other. He's aware of what he's doing but doesn't have to consider the meaning of it.

The doubled self is responsible for what it does—which often involves altering what murder means---and whatever the prior self gains from this shift reinforces the doubling behavior, ensuring more of it in the future.

The doubled self can act autonomously but can still be connected to the prior self from which it arises. That is, a doctor can view himself as a compassionate, humane person and still go out and kill. The killing self provides a means for the prior self to survive as much as possible without guilt. The killing self is the one doing the deeds, not the "real" self.

However, there's always the danger that the killing self can take over and become the dominant self, as seemed to have been the case with H. H. Holmes and many of the Nazi doctors. The killing self may so violate the prior self that it gives way, finally, to evil. Nevertheless, to call forth the evil in the first place was a moral choice, so the prior self is still morally responsible if not actively feeling guilty.

Depending on the personality involved, several types of doubling can occur:

The limited doubler: This person kills only under certain circumstances that he can somehow allow, such as in response to great financial or personal need. In Auschwitz, many doctors did what they were told in order to stay alive.

The enthusiastic doubler: This person is pleased to know that he can kill, get away with it, and still function normally. He has an adaptive affinity to it.

The conflicted doubler: Both parts of the self retain their power, so that killing produces guilt but the person cannot imagine resolution, so the killing continues.

Lifton believes that doctors as a group may be more susceptible to doubling than others, because they're used to skeletons and corpses, and because they learn to develop a "medical self" with a professional demeanor that may hide many things. They become inured to death and learn to function under many diverse demands. Add to that a heroic vision such as that offered by the Nazis and you get a lot of psychological support for doubling. They can be the paradoxical healer/killer, living in associated but separate realities.

Looking back on the cases, the idea of doubling seems to cover them all, although it still doesn't explain why a person would choose to double as a killer in the first place. To adapt to Nazi conditions is one thing, but to kill one's entire family or a succession of vulnerable patients is quite another. Doubling may be more insidious than adaptive, more an acceptance of the capacity for evil than a way to survive.

At least some countries are responding, however, by instituting more agencies to monitor death rates in hospitals and nursing care. Hopefully these safeguards will detect people like Shipman and Swango before they harm many people.

Family Doctor and Sexual Predator by Marilyn Bardsley

It's hard to imagine a family doctor who is more interested in the family's pretty teenaged girls rather than the health of his patients, but Josephakis Charalambous was just that. This was not an isolated incident, but a way of life for this most decadent of physicians.

A Canadian citizen, he had been born in 1952 of Greek parentage on the island of Cyprus, but had immigrated to Canada at the age of eight with his parents and siblings and settled in Vancouver, British Columbia. According to John Griffiths in Fatal Prescription, his father was a harsh man who was hated and disrespected by his family and who was eventually estranged from his wife and children.

Charalambous was indulged by his mother, who did everything she could to help him complete his medical education. Despite what appears to be a reasonably good relationship with his mother and sister, Charalambous had a very negative view of women. They were trash from his point of view: objects to be seduced and then discarded.

His desire to dominate and control women began early in his life and characterized his behavior in high school and university. Intimately tied into his desire to become a physician was his need to be able to attract desirable women with his professional status. However, his medical degree, once attained, was not the automatic magnet that he had hoped for. Women were not flocking to him and he often used prostitutes to satisfy his sexual requirements.

Things started to go seriously off track at age 33 when in 1985 he became obsessed with a 15-year-old girl, Shelley Joel, who was a patient of his, as were the other members of her family. Very much against the wishes of her parents, Charalambous pushed himself on the young woman and alienated her from her family.

Griffiths suggests that Charalambous married Shelley a couple of years later to avoid censure from the College of Physicians and Surgeons in Canada. All the time, the brainwashed Shelley was physically and mentally abused by him. And if that was not bad enough, he cheated on her with prostitutes. But that was nothing compared to his next move.

He had set out to conquer two young female patients Sian (pronounced Shawn) and Katie Simmonds. The girls complained to their father that the doctor had crossed the boundary of professionalism with his attentions. In 1991, their father went right to the College of Physicians and Surgeons with his concerns and the girls' formal complaints were lodged.

The subsequent trial transcripts stated: "It wasn't until November of 1992, that Charalambous was told that hearings into the girls' complaints would be held in March of 1993. On the morning of January 27, 1993, between 11:00 a.m. and 12:00 noon, Sian Simmonds was killed in her basement suite in Surrey, B.C. She was shot twice and then beaten on the head numerous times with a blunt object. David Walter Schlender confessed to the killing in exchange for police protection for his family. He entered a plea of guilty to second degree murder and was sentenced to life imprisonment without eligibility for parole for twenty years. The theory of the Canadian prosecutors was that Charalambous hired Brian West to arrange the murder of Sian Simmonds in order to prevent her from testifying against him at the College hearing, and that West had then hired Schlender to carry out the murder.

"David Schlender was a drug user and owed money to Brian West. West told Schlender that Simmonds and her sister had to be killed to prevent them from testifying against a karate instructor friend. Charalambous was a karate instructor. West threatened Schlender and his family several times. Schlender agreed to kill Simmonds and her sister. West provided Schlender with a handgun, silencer, and bullets. West then narrowed his instructions to include only the blonde girl that drove the red jeep and lived at the Simmonds' house.

"On 27 January 1993, after drinking beer and smoking cocaine with a friend named Brian Cann, Schlender drove alone in Cann's car to Simmonds' house. He then returned home and smoked cocaine with his wife. Finally Schlender went back to Simmonds' house armed with a gun. Once at the house, he scratched the door of her jeep with a key. Schlender went to the front door of the house and spoke to the upstairs resident who directed Schlender to the basement. He spoke to Sian Simmonds, telling her that he had accidentally scratched her jeep. She went outside with Schlender to examine the jeep and then the two returned to the residence. Schlender gave Simmonds Cann's insurance documents and went into the bathroom. Schlender emerged from the bathroom with the gun. He approached Simmonds who was sitting at the table and held the gun to the back of her head. Simmonds saw the gun and panicked. Schlender shot her and then beat her to death with the gun."

Clearly, the testimony of Schlender was very damaging to the doctor, but his wife Shelley did quite a bit on her own. Charalambous had told her too many details about the murder that she could not have known otherwise. When she testified about these details that her husband had admitted to her, it carried tremendous weight with the jury.

Charalambous was found guilty of first-degree murder and sentenced to life imprisonment with no possibility of parole until 25 years of the sentence had been served.

On May 13, 1997 Josephakis Charalambous' appeal was dismissed by the British Columbia Court of Appeal.

Dr. Bierenbaum's Missing Wife - Part One
by Marilyn Bardsley

Gail Katz was an attractive young woman from a solidly middle-class Long Island Jewish family. But she was a troubled girl suffering from low self-esteem, depression and anxiety. A bright girl, she nevertheless dropped out of college, popped Quaaludes and other pills, and drank more than she should. At one point, all of her neuroses, chemical dependencies and too much alcohol ganged up on her and she tried to commit suicide after breaking up with a boyfriend.

Unlike her sister, who was studying to be a lawyer, Gail was drifting without a clear goal in life. She flitted from relationship to relationship, none of them permanent. Then in 1979, at the age of 23 she met Bob Bierenbaum, a young doctor at Mt. Sinai Hospital in New York City. He had a very high IQ, played the guitar, flew small planes and wasn't bad looking. Better yet, he came from a good family and his father was an accomplished physician.

Bob pressed the relationship and soon they were engaged. Gail's parents were ecstatic: not only was he Jewish, but he was a doctor as well. Gail's practical side finally surfaced and she decided that, even though she did not really love Bob and didn't find him sexually attractive, he was too good a matrimonial catch to ignore.

Before they were married, she told her girlfriends of some unusual incidents that would come up many times in the future. Gail told people that Bob had admitted to inadvertently killing his former fiancée's cat. Then, when a stray cat that Gail picked up annoyed Bob, she claimed that he tried to kill the animal. To protect it, she took it to an animal shelter.

She also mentioned scenes that suggested that Bob was irrational and prone to fits of rage over things like finding her smoking.

Every one to whom she confided these incidents urged her to break off the engagement, particularly since she had serious doubts about her feelings about Bob.

To keep her parents happy and not lose a potentially huge meal ticket, Gail went ahead with the marriage. Things seemed to deteriorate almost immediately. They fought loudly and frequently. Once, she called the police and charged that he tried to choke her.

On the positive side, she went back to finish her college degree, but looked for extramarital relationships to satisfy the gaps in her relationship with Bob. Bob seemed to immerse himself in his career and was making himself into a first-class Manhattan surgeon.

Sunday morning, July 7, 1985, everything came to a head. According to Kieran Crowley, author of the very detailed book on the case, The Surgeon's Wife, "Gail, her pretty face contorted with rage, screeched a final ultimatum at Bob. She told him he was pathetic. She revealed her affairs, including her claimed liaison with an Arab. She declared that she loved another man and that she never loved Bob."

Mae Eisenhower in the apartment below heard the fight and said that it was followed by a loud slamming of a door, suggesting that one of the two combatants upstairs had stormed out of the apartment.

Shortly afterwards, one of Gail's friends called and Bob told her that Gail had gone out.

At 3 p.m., a retired textile executive, Joel Davis, saw a woman in a bagel shop that he was convinced was Gail.

At 3:30 p.m., Bob rented a Cessna at Caldwell Airport for a 2-hour flight. Afterwards, he attended his nephew's birthday party. Then he went to his friend's home and during the evening there called his house a couple of times to see if Gail had returned. Bob went home late that evening to an empty apartment.

The next day, Bob called around to several of Gail's friends, colleagues and relatives to see if they knew her whereabouts. He explained that they had argued and Gail had walked out.

Nobody had seen her and nobody had heard from her. She had simply vanished.

Dr. Bierenbaum's Missing Wife - Part Two
by Marilyn Bardsley

It seemed like all of Gail's friends and relatives knew without a doubt that Bob had killed her. Eventually, the police became persuaded as well. However, there was absolutely no evidence to tie him to Gail's disappearance. And there was Mae Eisenhower who heard the door slam after the argument. Maybe Gail walked out to link up with one of her boyfriends or someone who supplied her with the pills she took.

The police were happy to keep this drama as a missing person's case. Without a body, they were loathe to accuse a doctor from a good family with second-degree murder.

And so the case remained on a shelf for many years to come.

Bob had relocated to Las Vegas and became a very successful plastic surgeon. He was known for his acts of charity and his patients thought highly of him. After a number of brief relationships, he finally met another doctor, Janet Chollet, and they were married. In November of 1998, Janet bore him a daughter.

It looked as though things were finally going well in Dr. Bierenbaum's life. That is, until Andy Rosenzweig, an investigator in the Manhattan D.A.'s office was getting ready to retire. He wanted to close some old cases before he left the job.

New resources were put onto the case and people, especially Bob's old girlfriends and Gail's friends, were interviewed extensively. There were a few titillating discoveries but it was not clear that they were not the result of either bitter broken off relationships between Bob and former girlfriends and exaggerations by Gail in conversations with her friends and psychiatrists.

Still, there was no body and no real evidence to tie Bob to a crime. However, it did not stop a grand jury from indicting him and a jury from convicting him of second-degree murder. The woman judge, who was very hard on crimes against women, gave Bob 20 years to life.

It's not a pretty case: both Gail and Bob had serious personality flaws and never should have married. Bob's bad temper was reasonably well documented, but so was Gail's propensity to use drugs and alcohol to excess. She added a number of extramarital flings to her risky lifestyle. When she apparently stormed out of the apartment that morning in 1985, did she go looking for drugs or companionship with someone that was ultimately responsible for her disappearance? Also, it was well documented that Gail suffered from depression and suicidal tendencies which could have also led to her final disappearance.

It is not beyond reasonable doubt that someone other than Bob was responsible for Gail's disappearance. Furthermore, despite Bob's guilt or innocence, it is disturbing to see a man convicted on such circumstantial evidence. He was, after all, a man of accomplishment who was leading a perfectly respectable life as a member of his community, a charitable surgeon, a good husband and father.

The Science of Fasting

During the turn of the nineteenth century and into the early years of the twentieth, spas for the wealthy that purported to "cure" people of contemporary ills were all the rage. Sometimes they offered genuine service but often they were full of quackery, poised simply to siphon off money from trusting clients. Kenneth V. Iserson, in Demon Doctors, and Gregg Olson, in Starvation Heights, offer an account of a female doctor who used her "medicine" for sinister ends.

Dr. Linda Burfield Hazzard set up her operation in 1907 in Seattle, Washington, and offered several versions of a published manual of her special method. One of the few female doctors in the country (trained as an osteopath), she presented herself as the only licensed fasting therapist in the country, and her final domain was a sanitarium, Wilderness heights, in the small town of Olalla, across the Puget Sound from Seattle. It was an isolated place, with no way to communicate with the outside world. Exuding self-confidence, Dr. Hazzard assured people that her method was a panacea for all manner of ills, because she was able to rid the body of toxins that caused imbalances in the body. As strange as it may seem, she managed to persuade people to go without food, aside from some water and a thin tomato and asparagus soup, for long periods of time. As their bodies shed "toxins," she required enemas (a fashionable purgative in many such places) and provided vigorous massages meant to accelerate the process.

As patients weakened, Hazzard found ways to encourage them to turn over to her their accounts and power of attorney. Not surprisingly, several died under her "care" and she grew richer. Her bigamous husband, Sam, helped get the patients, once they were very weak, to change their wills to make Dr. Hazzard their beneficiary. Yet when attacked for her methods as patients died, she insisted that they had been near death when they came, and she could not be expected to work miracles. Even with these dire stories, she still drew both disciples and patients from around the world. Local residents dubbed the place Starvation Heights, and it caught the attention of authorities when two wealthy British sisters came to "take the cure."

The Deadly Result

Claire and Dora Williamson had received a copy of Fasting for the Cure of Disease, Hazzard's publication. It purported to have resulted in remarkable recoveries for people who had found little help elsewhere. Hazzard was a natural salesperson who had spread her ideas to an international audience. She had published testimonials from success stories, and the sisters were impressed. A fan of natural cures, they checked in for the treatment on February 27, 1911.

They did not realize that, once there, they would not be able to just leave. In fact, they would be too weak to do so. They agreed to undergo the rigorous fasting, shedding weight to the point where they were nearly mere skeletons. As they grew weaker, Olson points out, they became more committed to the therapy. Suffering was a sign, they were told, that the treatment was working. Even when they became bedridden after two months, the doctor would not allow them to eat. At the same time, she secured their jewelry and land deeds, to "prevent others" from coming into their apartment to rob them. Then she moved them to her newly completed sanitarium, where they could communicate with no one. At that time, they weighed around 75 pounds each and were often delirious.

Claire managed to secretly find someone to send a telegram, but she eventually died, even as Margaret Convey, a faithful nanny, rushed there from Australia. Convey rescued Dora, now said to be insane, before she met the same fate. Dora had been on the treatment for four months, but with Convey's help, she regained her health and proved to be an effective witness—especially photos of her during the latter stage of the fasting cure--when the case came to trial in 1912—as murder. Hazzard was found guilty of manslaughter. The medical establishment removed her license during the legal proceedings, and she claimed that the verdict was just part of the persecution she had suffered all along. The Town Crier wrote that her gender had saved her from the verdict of murder.

During her appeal, two women and two babies died at her center. She spent only two years in prison, and in exchange for her leaving the country, the governor granted a pardon. She went to New Zealand, but eventually returned to Olalla, writes Iserson, and resumed her treatments. Arrested again when another man died, she was fined for violating medical practice. Since she kept no records, the number of people who died (or were intentionally starved to death) under her "care" cannot be estimated.

Oddly enough, Dr. Hazzard's book is available today on several Webs sites that tout her treatment as scientific and effective, but the Skeptical Inquirer assures readers that the claims Hazzard made for its health benefits are both vacuous and bogus.

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