'Sadism shouldn't be conflated with mental illness': Exclusive interview on Lucy Letby with forensic psychiatrist

A few chilling words scribbled by British killer nurse Lucy Letby are perhaps the closest look we will get into her twisted mind. “I AM EVIL, I DID THIS,” she wrote in a note, adding that she did “nothing wrong.”

“Police investigation forget slander. Discrimination. Victimisation. All getting too much everything taking over my life. Hate myself so much for what this has . . . I feel very alone and scared,” Lucy wrote. “What does the future hold. How can I get through it. How will things ever be like they used. HATE. PANIC. FEAR. LOST. I don’t deserve to live. I DID THIS. WHY ME. I killed them on purpose because I’m not good enough for them and I am a horrible evil person. I don’t deserve Mum and Dad. World is better off without me.”

While Lucy’s motive for murdering several babies may never be known, a qualified Consultant Forensic Psychiatrist who assesses, treats and rehabilitates criminals who are mentally disordered has given us a glimpse into Lucy’s mind. Dr. Sohom Das works with people in courts, prisons and psychiatric units.

“Lucy is very unique compared to the rest of the offender population I have assessed,” Sohom said in an interview with Hindustan Times. “One major reason is that there were almost no red flag warnings. She wasn’t aggressive, antisocial, hostile or cantankerous. As far as we know, there is no trauma in her history. She wasn’t, for example, a victim of abuse. She had no criminal history or even issues relating to friends and peers. In fact, before baby deaths started spiking, she was seen by her colleagues as diligent and conscientious.”

Lucy was sentenced this month to life in prison with no chance of release for killing seven babies in her care, and attempting to kill six others as a neonatal nurse in Chester Hospital in Cheshire, England. The 33-year-old is now being considered one of the most prolific child killers in the history of the United Kingdom.

Was Lucy Letby battling mental health issues?

“It is difficult to know Lucy’s incentives, as she has not opened up her psyche to the world. However, we can look at some of the most high-profile healthcare professionals who committed their crimes, and compare and contrast. Beverley Allitt, also an English nurse, was convicted of murdering four infants, attempting to murder three others, and causing grievous bodily harm to a further six in Lincolnshire between February and April 1991. She had Munchausen’s by proxy. This contentious disorder leads the individual to intentionally fake or even artificially create illness. The perpetrator gets some sort of perverse pleasure from feeding off the sympathy and attention that is afforded to the victim,” Sohom explained.

“With Harold Shipman, an English doctor, considered to be one of the most prolific serial killers in modern history, with an estimated 250 victims, there seemed to be a ‘God complex’. His thrill was from holding the fragility of death in his hands and the power of deciding who lives and dies. With Lucy, I imagine that there were elements of both of these notorious killers,” he added.

Sohom said there may have been other motives, such as power and control or “a morbid fascination with the parents’ grieving process.” “It is also possible that she took some perverse pleasure in deceiving parents, i.e. being the cause of their baby’s death yet also the person who comforts them. She may have also been jealous of the ideal family unit, perhaps as in her mind it was somehow obtainable. In her bitterness, she decided to simply annihilate what she couldn’t have,” he added.

On being asked whether Lucy may have been battling mental health issues, Sohom said, “It has been established that Lucy suffered from some background anxiety and depression. However, crucially, in my view, this did not affect her criminal culpability. It may have given her a negative outlook on life, but that still does not explain and certainly does not excuse what she did.”

‘Warped intentions and twisted, dark, vile thoughts’

The world has had no dearth of sadistic healthcare professionals who brutally murdered their patients. Niels Högel injected his patients with cardiovascular medication, killing six people, although it is believed the actual number of victims have been close to 300. He has been dubbed Germany’s worst post-war serial killer.

Former nurse Charles Cullen’s killing spree went mostly unnoticed while he worked at various hospitals in the New Jersey area, and he ended up murdering as many as 45 patients.

British nurse Benjamin Geen was found guilty of killing two patients, while Wesh nurse Barbara Salisbury tried to kill two elderly patients in 2002, to try and empty hospital beds during a bedblocking crisis.

Sohom, whose subjects are typically assault, rob, stab, set fires and rape, opened up about mental health illnesses that may drive most of these offenders to commit the crimes, saying, “In terms of a severe mental illness that controls their actions, such as psychosis, this is almost never the case with killer healthcare professionals. I do see this in some of my offenders, such as women with delusional beliefs about their babies being marked by the devil and therefore killing them in order to save them for the afterlife. This might sound extreme but I have seen it more than once in my career. However, I would emphasise that this is almost impossible to be prevalent in high functioning doctors and nurses, such as Lucy and Harold Shipman. They might have some very warped intentions and twisted, dark, vile thoughts and fantasies. Lucy may have had an element of anxiety and depression in the background. But crucially, this did not drive her actions or compel her; she was fully in control and knew what she was doing. She was aware of the damage she was causing. In short, this is sadism, and should not be conflated with mental illness.”

‘We must not sympathise with these killers’

Sohom explained that all of these killers have one thing in common – they abuse their position of authority for exposure to vulnerable victims. “I suppose a sinister chicken and egg quandary exists; do people with these morbid, heinous intentions drift into these roles or do they become this way through their work? Although we must not sympathise with these killers, one could postulate that being exposed to trauma and death could make them become somewhat desensitised and thereby warp their moral boundaries,” he said.

Sohom added, “However, I personally do not subscribe to this. If it was a significant factor, surely a greater proportion of workers in these sectors would turn out to be murderous. This is why I believe they mask their intentions and lower everybody’s guard by projecting a caring and professional persona.”

Notably, Lucy refused to attend court for sentencing. She clearly did not intend to come to the dock, or take part in the hearing. Do these killers ever regret their actions? Sohom said “they have very conflicted internal cognitions.”

“Despite the cruel acts, it is very feasible that a minuscule part of them does feel some sort of guilt and shame. In fact, I think we saw this with Lucy’s notes which offered a glimpse into her psyche. After these individuals have been imprisoned, sometimes it might take months or even years for them to reflect on the consequences of their actions. They might develop genuine remorse retrospectively. But of course, this is little consolation for the victims’ families,” Sohom said.

‘Almost all criminals were once victims themselves’

Sohom also works as an Expert Witness for criminal trials, assessing defendants who have committed serious crimes. He typically examines medical records, CCTV footage, police interview transcripts and witness statements, and speaks to their psychiatrists.

“I use this information to either declare that there is no mental illness or formulate a diagnosis, if there is one. I then filter out the very small proportion of offenders who are not criminally responsible and need to be rehabilitated for long-term treatment within a secure psychiatric unit, rather than punished and imprisoned. As you might suspect, a significant proportion try to fake or exaggerate symptoms, and I’m the guy who has to catch them out,” he explained.

“One of the most sobering and important lessons that I’ve learnt in my career is that almost all criminals were once victims themselves. I see a pattern of trauma and/or social disadvantage in the vast majority of the defendants I assess – from abusive parents to marginalisation by society, to abstract poverty to drug and alcohol addiction. The recent increase in financial strain in society is likely to result in a huge increase of crime in the future. I say ‘almost all,’ because there are rare exceptions. Lucy seems to fit into this category,” he added.

Sohom could not name the patients he has worked with due to the doctor/patient confidentiality, but he has used pseudonyms to talk about them in his book ‘In Two Minds: Stories of Murder, Justice and Recovery from a Forensic Psychiatrist’. The most extreme kinds of cases Sohom has dealt with included psychotic mothers who have killed their own children, as well as people who have murdered random strangers. Some were stabbed, and on some occasions, pushed in front of a train.

‘The managers have blood on their hands’

It has been revealed that multiple warnings about Lucy went unheeded by the hospital. Shockingly, the Countess of Chester Hospital Foundation Trust contacted the Cheshire Constabulary, which is the police force responsible for the area, only in early May 2017. This was about a year and a half after doctors at the hospital began raising suspicions about the babies’ deaths.

The court heard during the trial that several paediatricians who worked alongside Lucy had alerted hospital executives about the nurse on multiple occasions. “Lucy is responsible for the death of those defenceless babies. But I also believe that the managers have blood on their hands,” Sohom said.

Can more cases like Lucy Letby be prevented?

“It pains me to say this, but I’m not sure that we can prevent another case like Lucy Letby from occurring, because there were no warning signs or external indications of her behaviour. It would simply be unrealistic to expect somebody to oversee the actions of all doctors and nurses. Although I would always advocate an increase in mental health awareness, I don’t think this would have made a difference in this particular case,” Sohom said.

He added that the solution is twofold. “Firstly, accountability. We desperately need a transparent, independent system where potential negligence or brutality is thoroughly and openly investigated. This must be overseen by an objective, impartial and neutral body. Not hospital managers within the same Trust as the perpetrator. We can’t have turkeys voting for Christmas,” he said.

“Secondly, and perhaps less obviously, remuneration. In my view, we must pay public sector workers more. I hope this goes without saying, but the vast majority of nurses and doctors are compassionate, caring and competent. They do extremely stressful and, at times, risky work, and yet they get paid a pittance,” he continued.

“This is reflected in the numerous recent strikes in England, by both doctors and nurses. Underpaying healthcare professionals attract a lower calibre of recruits. Those who are hardworking, driven and intelligent are more likely to be poached away for managerial roles, thereby further diluting the quality of those on the front line. I say this as a doctor myself, and I see this with my own eyes. If you improve the overall quality of those in these professions, then inevitably the culture and the standards will also improve,” Sohom concluded.

Sohom shares insights into Lucy’s case on his YouTube channel, where he is “trying to educate the masses about a whole range of issues related to criminality and mental health.”