The secret world of Harold Shipman

The former doctor still refuses to talk about his crimes

Why did he do it? What drove Harold Shipman to kill his patients? BBC News Online's Peter Gould, who covered the trial, looks at the questions left unanswered.

The exact number of Harold Shipman's victims may never be known.

He has never revealed anything about the extent of his murderous career, and probably never will.

According to a leading psychiatrist who has studied his case, Shipman is incapable of acknowledging the truth, even to himself.

"He has got a huge defence mechanism against the incursion of reality," said the doctor, who for professional reasons cannot be named.

Harold Shipman has no real understanding of what he has done

Forensic Psychiatrist

"He has probably found a way to disguise to himself what he has done.

"The experience of killing was intensely personal and private to him, and he is never going to give that up.

"We are never going to know the truth. All we can say is that he has been killing people for years."

Questions

For those of us who sat through the trial of Harold Shipman at Preston Crown Court, it was a case that left many unanswered questions.

Above all, what was it that turned a middle-aged family doctor into one of the world's most prolific serial killers?

Harold Shipman, aged five

In trying to explain Shipman's actions, the Crown said he had clearly enjoyed exercising the power over life and death.

But some psychiatrists believe that the word "enjoyment" is misleading, because Shipman was driven by a need to kill.

The problem may stem from a traumatic event early in Shipman's life. The death of his mother from a particularly painful illness, when he was still a teenager, would have had an impact on the development of his personality.

Was he unable to come to terms with the memory of what happened, and the fact that he was powerless to help her? And did this have a bearing on his decision to become a doctor?

Similarities

In the 15 cases that formed the basis of the trial, there was a striking similarity in Shipman's choice of victims, and the manner of their death.

They were mostly elderly women who lived alone. They were in good health for their age, until he injected them with lethal doses of Diamorphine, the medical term for heroin.

Killing by injections

Serial killers usually have a sexual motive, and they continue killing in order to satisfy that desire. The frequency of their crimes may increase because of this compulsion, which is why they are eventually discovered.

But although Shipman's known victims were women, there was no suggestion in court of any sexual element in the killings. And according to the psychiatrist, the motive for the murders lies in some deep-seated personal need.

"Dr Shipman could only get what he wanted from killing elderly women. He did it to make himself feel better. But his focus was on the act of killing, and it was important to him to be in control of the process.

Control

"In some ways you can view him as a necrophile because he needed bodies. But he had no interest in them after death. It was the killing - the point of death - that interested him.

The experience of killing was intensely personal and private to him, and he is never going to give that up

Forensic Psychiatrist

"Dr Shipman is a fairly extreme example of a control freak. The dreadful thing is he killed lots of people, not for pleasure, but to make himself feel more normal.

"In his mind, the killings would have been outside the normal moral framework, so he would not feel any remorse."

So why did he choose to kill his victims by injecting them with heroin? In part, because it would not have aroused any suspicion on the part of his victims. What more natural than having an injection from a trusted family doctor?

Injections

But it may be symbolic that the instrument of death chosen by Shipman was a hypodermic syringe. Giving injections was part of his professional life, and he took pride in his reputation.

Shipman on his way to prison

Some of his victims were found in an attitude of repose, almost as if he had taken care to end their lives in a peaceful manner.

"It was extremely important to him to be regarded as a good doctor," said the psychiatrist.

"Yet there is a lot of suppressed anger in the killings. He has difficulty dealing with emotions, and the murders appear to have been a solution to something that threatened his sense of mastery over himself.

"But he has no real understanding of what he has done."

So exactly what made Harold Shipman a killer remains locked inside his head, along with the details of just how many of his patients he murdered.