Angels of Death: When Healthcare Professionals become Murderers

Film Review by Franco Ferrarini, Introduced by Khalid Ali

Healthcare professionals, especially doctors and nurses, have public trust to do the best for their patients when these patients are most vulnerable. Saving lives, maintaining patients’ safety and dignity are core principles of the care profession. Unfortunately, widely publicized cases have shown that some doctors can turn into serial killers; the story of Harold Shipman was a tragic eye-opener.

A recent case of another NHS doctor killing his partner’s father was a sad reminder criminal tendencies can be found in some doctors. Simon Bruce, a senior family law specialist solicitor who was part of the legal team investigating this doctor stated: “It is truly horrifying that any doctor who has signed the Hippocratic Oath would be responsible for killing someone else and attempting to kill other people.”

Keeping a watchful eye to spot the few hidden criminals in the healthcare profession is a collective responsibility. In his review of the TV series ‘The Fall’, Dr Franco Ferrarini describes some psycho-pathological characteristics of ‘serial killers.’


‘Between the Idea and the Reality Falls the Shadow’ (“The Hollow Men”, T.S. Eliot, 1925)

“The Fall” (TV series, directed by Allan Cubitt, UK, Ireland, 2013), available to watch on Netflix

At first glance ‘The Fall’ could be seen as the usual “cop vs serial killer” story where both the cop and the killer are traumatized by demons from their past but confronting them in different ways: the cop by chasing criminals, and the killer by targeting innocent people. Paul Spector’s (the killer, Jamie Dornan) mother took her life when he was still a child. Following that tragedy, he wandered among foster families and orphanages where he was subjected to repeated psychological and sexual abuse. Stella (the cop, Gillian Anderson) was very close to her father (as a matter of fact she never mentions her mother) but did not forgive him for dying when she was just 13, leaving her alone; moreover, her dreams, which she carefully describes in her diary, reveal that she was sexually attracted to him. Paul declares that torturing and killing his victims is an act of justice: since he suffered in his childhood, his victims must now suffer to balance the score. By believing that perverse logic, he takes on the role of the Nietzschean Übermensch,1 a man guided by his own moral values which override the common boundaries of Good and Evil and endow him with the power of deciding who deserves to live and who must die. This belief is clearly shown in his notes, where we see citations of Friedreich Nietzsche’s philosophy. But there is an additional personal note: Paul tortures and kills exclusively women to take revenge against his mother who left him alone in the world; he strangles his victims with bare hands or suffocates them with a plastic bag, both acts resonating with his mother’s suicide by hanging. What about Stella? She reacts to her hidden desire towards her father by adopting a masculine role in her sexual relationships, with both men and women.



There are several possible interpretations beyond the above analysis, which one may suspect after observing that all the adult women in the series play a positive role, whereas all the male characters in one way or another display at least some negative aspect. This notion of ‘women superiority’ is evident in a scene where Stella is asked by Mr. Burns (John Lynch), her superior and former lover, ‘’why women are emotionally and spiritually stronger than men?’’ She simply answers that ‘’females are the perfect human beings whilst males are just a biological error’’. One could thus argue that the title ‘The Fall’ hints at Adam’s and Eve’s loss of innocence (Genesis 3:13), however men in the series play Eve’s role, since they are responsible for the wrongdoings portrayed in the narrative, contrary to the narration in Genesis where Eve holds the responsibility for humanity’s demise and fall from Heaven. Nevertheless, the series title may convey yet another meaning. In one of the first episodes, we fleetingly see among Paul’s notes and sketches a sentence from a T.S. Eliot’s poem “The Hollow Men”: Between the Idea and the Reality falls the Shadow.2 The blurred line between ideas and reality is revisited in the last episode when Paul, questioned about the reasons of his killings echoes the same concept. According to the theory of the archetypes by the Swiss psychoanalyst Carl Gustav Jung (1875-1961),3 the Shadow is the evil part of our unconscious mind. By acting at an unconscious level, the Shadow may ominously influence the outcome (Reality) of what had been initially conceived (the Idea). Why does Paul refer to the ‘Shadow’? From a phenomenological psychiatry viewpoint, it could be a hidden call for help: his mind knows that its ideas are twisted by the ‘Shadow’ but at the same time it cannot resist its devious influences.

The traumatic events in Paul’s and Stella’s childhood might explain their later life trajectories. Paul’s modus operandi perfectly fits with the model of the “organised” serial killer4 as he carefully chooses his victims, and his actions follow a detailed routine. He has been the victim of sexual and psychological abuse in his childhood, traumas which are usually more frequent in serial killers’ childhood vs the general population’s.5 His psychopathological profile, as often observed in serial killers,5 falls under the Anti-Social Personality Disorder coupled with narcissistic features, poor impulse control, and a peculiar capacity to appear likeable to others, as shown by his young baby-sitter Katie Benedetto falling in love with him and the affection shown towards him by nurse Keira during his hospital stay in the Intensive Care Unit. These psychopathological features have been correlated with abnormalities in function and morphology of the pre-frontal cortex, the amygdala, and the hippocampus.6,7 implying an incapacity to evaluate the moral consequences of one’s actions and a lack of empathy. Whether these changes are inborn or acquired during childhood experiences is not yet clear.

As for Stella, her life course does not fit in completely with the typical anxiety-depression-loneliness profile of children who lose one or both parents, which is more often seen in female subjects because of their need for a father-figure to shape their gender role in society and to enhance their self-esteem and life satisfaction.8 One may hypothesize that her masculine, not to say almost predatory, attitude in her sexual relationships (frequently one-night stands) reflects her frantic search for a paternal figure, or, maybe, a desperate desire to fill her life, which is almost exclusively devoted to her job. In fact, in the end of the last episode, the loneliness of her homecoming is clearly emphasized.

Even if “The Fall” can be slow at times, it still is a thought-provoking series for the accuracy of describing Paul’s and Stella’s characters by using psychological metaphors and hidden messages within the narrative. Gillian Anderson’s and Jamie Dornan’s acting may seem at times expressionless; however, this style of acting effectively underlines their characters’ inability to maintain meaningful human relationships with others because of their traumatic past.



[1] “Thus spoke Zarathustra: a book for everyone and nobody”, Friedrich Nietzsche, Oxford University Press, 2008.

[2] “T.S. Eliot Collected Poems 1909-1962” Harper Collins 1963.

[3] “The Archetypes and the Collective Unconscious”, Carl Gustav Jung, WW Bollingen series, Princeton.

[4] Mitchell H and Aamodt MG. ”The Incidence of Child Abuse in Serial Killers”. J Police Crim Psychol 2005;20 (1):40-47.

[5] Reid S, Katan A, Ellity A et al. “The Perfect Storm: Mapping the Life Course Trajectories of Serial Killers”. Int J Offender Ther Comp Criminol 2019; 63(9):1621-62.

[6] Harenski C L, Edwards B G, Harenski K A et al. “Neural correlates of moral and non-moral emotion in female psychopathy”. Front. Hum. Neurosci 2104, doi: 10.3389/fnhum.2014.00741.

[7] Reid, S. “Developmental pathways to serial homicide: A critical review of the biological literature”. Aggression and Violent Behavior 2017;35:52-61.

[8] Allgood SM, Beckert TE, Peterson C. The Role of Father Involvement in the Perceived Psychological Well-Being of Young Adult Daughters: A Retrospective Study. N Am J Psychol 2012;14(1):95-110.

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