The Angel of Death
Cullen was a hospital nurse, who confessed to murdering as many as 40 patients over 16 years by injecting them with overdoses of insulin. Cullen had a prolonged history of difficult life conditions. He attempted suicide multiple times, beginning as early as age nine, felt lonely, teased people, got divorced and suffered severe levels of depression (Graeber, 2013). While repression, i.e., blocking the accessibility of stress-related thoughts, played an important function in reducing his emotional distress, it seems that one major factor that affected him to choose this type of madness, rather than other coping measures is controllability: By killing others, he inflated his self-esteem to such a high level that he no longer felt miserable and suicidal. Indeed, in an interview with CBS' "60 Minutes," Cullen noted, regarding his suicide attempts, "I tried to kill myself throughout my life because I never really liked being who I was. I didn't feel I was worthy of anything." While, officially, he was just another hospital nurse, practically, in his new position as a murderer, he was God-like, making life and death decisions. Furthermore, some of Cullen's attempts to kill his patients granted him the opportunity to reinforce his professional status in the hospital. As noted by Graeber (2013) "Cullen was the first to respond to the screaming "code blue" and start resuscitating a failing patient. Because he had administered the cocktail of drugs that sent the victim into trouble, Cullen seemed almost magically prescient when he knew what drugs to administer to undo the damage and save the day.
Another factor that affects the choice of criminal behavior is availability. As illustrated above with regard to Vanunu, people may utilize their professions or work places for criminal acts if these are suitable for their coping aims. This is also demonstrated in Cullen's case. As a nurse he could conceal his serial killings for many years particularly because he used medications normally employed to save people's lives. Drugs like digoxin, commonly used to help regulate heart rhythm, can become deadly when employed in large enough doses and injected into a patient’s IV port. It was especially lethal to patients with a history of heart problems. Insulin was another drug Cullen frequently used, sending patients into spiraling diabetic comas and generally stressing their already fragile systems. The role of one’s profession or work place in choosing a specific criminal act to carry out is also seen in the case of Andreas Lubitz, the 27-year-old co-pilot of German wings flight 9525, who intentionally crashed into the French Alps on 24 March 2015 (Wikipedia, 2015).
Additionally, Cullen had a history of violent behavior prior to his serial killings. His wife filed two domestic violence complaints against him and requested a restraining order that was not granted. Further, in March of 1993, Cullen broke into the home of a co-worker, whom he once dated, while she and her young son slept, but he left without waking them. After, he began contacting the co-worker frequently, leaving numerous messages, and following her at work and around town, the woman filed a police report. He was arrested and then tried to commit suicide. Cullen pleaded guilty to trespassing and received one year's probation. Thus, the idea of killing became salient in Cullen's mind through his ability to administer drugs in a professional capacity along with his strong aggressive tendencies that were aggravated by his extreme level of depression.
This case meets all five of PBT's diagnostic criteria. Thus, the killing behavior intensively preoccupied his attention and severely disrupted his daily life (1); the dramatic change in his behavior could not be explained by any observable event (2); the patient was unaware of the underlying causes of his criminal behaviors. When asked about the reasons for his criminal acts, he first said he thought he was helping people by ending their suffering. However, Cullen told a different story when reminded of the fact that some were not close to death or suffering from great pain. He said there was "no justification" and that he "felt overwhelmed at that time." When pressed by the interviewer from "60 Minutes," for an explanation for the families of his victims, he said "...It felt like I needed to do something and I did. And that's not an answer to anything." (3); his serial killings were undoubtedly rare (4); and his behavior was diagnosed as reflection of madness (e.g., see Graeber, 2013) (5).