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- [00:02]
Vanessa Richardson
Hi, it's Vanessa. If you're drawn to true crime stories about disappearances, there's a new Crime House original you should check out. It's called the Final Hours, hosted by Sarah Turney and Courtney Nicole. Sarah's an advocate for missing and murdered victims whose own sister disappeared in 2001. And Courtney is a true crime storyteller who's seen firsthand how crime can change a family forever. Together, they bring lived experience to every case, examining the moments just before a person disappears. The routines, the timelines, the small details that often get overlooked because every disappearance has a moment where everything still feels normal. Until it doesn't. Listen to and follow the final hours on Apple Podcasts, Spotify, Amazon Music, or wherever you get your podcasts. New episodes drop every Monday. This is Crime House. Everyone should be able to trust their doctor to believe they're here to help and to assume the person in the room knows what they're doing. Most of the time, that trust is deserved. But when authority goes unquestioned and expertise shields someone from scrutiny, it can become a weapon. In the town of Hyde, England, that weapon had a name. Dr. Harold Shipman. For over two decades, Harold used a derivative of morphine to quietly murder his own patients. In the process, he became the most prolific serial killer in British history. And to this day, no. No one knows why he did it. The human mind is powerful. It shapes how we think, feel, love and hate. But sometimes it drives people to commit the unthinkable. This is serial killers and murderous minds. A Crime House original. I'm Vanessa Richardson.
- [02:21]
Dr. Tristan Engels
And I'm forensic psychologist Dr. Tristan Ingalls. Every Monday and Thursday, we uncover the darkest minds in history, analyzing what makes a killer.
- [02:31]
Vanessa Richardson
Crime House is made possible by you. Please rate, review and follow serial killers and murderous minds to enhance your listening experience with ad. Free early access to each two part series and bonus content. Subscribe to Crime House plus on Apple Podcasts. Before we get started, be advised this episode contains descriptions of murder and medical abuse. Please listen with care. Today we begin our deep dive on Dr. Harold Shipman, the most prolific serial killer in British history. Harold was a family doctor who earned the trust of everyone in his small town. No one had any clue how dangerous he was until Harold left behind a single bewildering clue.
- [03:15]
Dr. Tristan Engels
And as Vanessa goes through the story, I'll be talking about things like how early exposure to illness, pain and death can shape how a killer is drawn to violence. Or what substance abuse may say about a killer's psyche. And what peaks and valleys in their Killing Spree might suggest about their motives.
- [03:32]
Vanessa Richardson
And as always, we'll be asking the question, what makes a killer? Spring is here. Which means it's time to refresh your wardrobe for warmer days, spring break plans, and all the busy life in between. But let's be honest. Finding clothes that fit your style and schedule, that's easier said than done. That's why Daily look is perfect for busy women like us. Daily look is the number one highest rated premium personal styling service for women. You get a dedicated personal stylist who curates a box of clothes based on your body shape, style preferences and lifestyle, delivered straight to your door. Real stylists, not an algorithm. And you get the same stylist every time, so your wardrobe always feels personal. Each box can have up to 12 premium pieces. Try everything on at home. Keep what you love, return the rest. Shipping is free both ways with flexible delivery every 30, 60 or 90 days. Refreshing your spring wardrobe has never been easier. It's effortless style saving you time and energy so you can focus on everything else this season, elevate your style by signing up@dailylook.com today. Take your style quiz@dailylook.com and get 50% off your first styling fee with the code SERIAL. That's dailylook.com code S E R I A L. Hey, Sal.
- [04:58]
Dr. Tristan Engels
Hank.
- [04:59]
Hank
What's going on?
- [05:00]
Unknown Advertiser/Voice
We haven't worked a case in years. I just bought my car at Carvana and it was so easy.
- [05:04]
Hank
Too easy.
- [05:05]
Vanessa Richardson
Think something's up?
- [05:06]
Unknown Advertiser/Voice
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- [05:14]
Hank
It sounds like Carvana just makes it
- [05:16]
Unknown Advertiser/Voice
easy to buy your car. Car, Hank. Yeah, you're right. Case closed.
- [05:21]
Dr. Tristan Engels
Buy your car today. On Carvana, delivery fees may apply.
- [05:28]
Vanessa Richardson
Harold Shipman learned early on that suffering could be managed if someone was willing to take control. On June 21, 1963, 17 year old Harold stood at his mother Vera's bedside. She was 43 and 40. For months, he'd watched her body and spirit be decimated by lung cancer. Inside their red brick home in Nottingham, England, everything revolved around her recovery. But it was a losing battle. And that was especially hard on Harald. He was closer to his mother than any of his siblings. Before Vera got sick, she waited for him to come home from school each afternoon with a fresh pot of tea, eager to hear about his day. But as her condition worsened, Harold became her caretaker and their routine gave way to round the clock nursing. Eventually, Harold's care wasn't enough. To ease her pain, Vera's doctors prescribed her morphine. Harold watched closely as each injection took effect, easing her suffering. Her breathing slowed and the tension left her body. Then, on the morning of June 21, 1963, Vera Shipman died. With her husband and children at her side, Harold noticed that the morphine had done its job. She'd passed peacefully. He was grateful for that.
- [06:52]
Dr. Tristan Engels
So this is a very profound experience for anyone to witness. And the impact will vary depending on a number of factors, starting with age. Harold was 17, which places him in late adolescence, a stage where people are forming their identity, their beliefs about the world, and their understanding of power, responsibility and control. Experiences during this time can have a lasting influence, especially when you also consider that their brain is still developing. Watching a parent that he was very close to suffer over a long period and then die in what appeared to be a very peaceful way could create a strong association between death and relief from suffering. It may also have brought him a sense of personal relief from the anxiety, distress and emotional strain of that experience alone. Because, like you said, he was taking care of her for a period of time that could have restored some control or power in his own life. And for a 17 year old whose emotional regulation systems are still developing and they are still forming their moral frameworks, an experience like that can shape how they think about authority, power, caregiving, and even the role of medical professionals in something like this. And of course, many adolescents experience the loss of a parent and they go on to live healthy and pro social lives. This experience is not a direct cause for later violence or offender behavior.
- [08:17]
Vanessa Richardson
So in terms of Harold seeing how morphine affected his mother, do you think gratitude can serve as a coping mechanism for grief? And if it can, can that lead to someone drawing false conclusions or silver linings about that?
- [08:31]
Dr. Tristan Engels
Yes, absolutely. Focusing on gratitude can help the brain make the experience feel more tolerable to the person. We also call this meaning making, where people try to construct a narrative that helps them cope with a difficult experience like. But that process can sometimes lead to oversimplified or distorted conclusions, especially in adolescents who are still forming their beliefs about the world. So if they see a loved one suffer and then they receive morphine, and then they watch them die seemingly peacefully, they might begin to link those events in a very direct way. So instead of understanding the full medical context, they may internalize a simpler message, like doctors can control suffering and death. And that's not necessarily accurate in the broad sense, but it sounds comforting to them in a time like that. It also gives someone the illusion of power in a previously powerless experience. But that said, most people use gratitude and meaning making in their grief in very healthy and constructive ways. Like forming non profits in the name of a loved one, Focusing on time with family or volunteering and more.
- [09:42]
Vanessa Richardson
In Harold's eyes, the doctors had done a great kindness. After seeing how they helped his mother die painlessly, he decided he wanted to be able to do the same thing for others when he got older. So he set his sights on medical school, specifically the University of Leeds. The decision wasn't just about a career. It was tied to the last lesson his mother had left him. Before she died, Vera told Harald how important it was for him to make something of himself. Their family had always gotten by financially, but they'd never thrived. His father supported them on a truck driver's salary while Vera ran the household. So to Harold, becoming a doctor would mean more than stability. It would be a way for him to live up to his mother's expectations and help others the way doctors had helped her. He became singularly focused on this goal. He kept his head down at school and followed all the rules. His main form of release was playing rugby for his school's team. But Harold never talked much to his friends or even his family about the lingering grief he felt over losing his mother. Part of that was because his father worked long hours and his siblings were busy with their own lives. So Harold tried to do the same. He kept his head down, studied and tried to move forward.
- [11:03]
Dr. Tristan Engels
When grief doesn't simply disappear, which it tends to not do, that's especially true when it's not fully processed. Then unprocessed grief shapes a person's emotions, beliefs and coping strategies over time. Grief is meant to be worked through. It's meant to be talked about and felt and integrated into a person's understanding. But if someone doesn't have the support or emotional tools or the environment to process their loss, the feelings can become suppressed or compartmentalized. And on the surface, they can appear functional, like Harold appears right now. But underneath, the grief is still influencing how they respond to things like stress or relationships and even vulnerability. Unprocessed grief can lead to certain coping patterns too. Some people become emotionally detached or avoidant. Others may become overly controlling or even rigid, trying to prevent situations that remind them of the helplessness they once felt. And some may turn to maladaptive coping strategies like substance use or risk taking behavior. All to manage unresolved emotional pain. It can also shape a person's core beliefs about the world. With Harold, it Sounds like he didn't have a lot of support. His father wasn't home very much because of his job, and it sounds like he did not have a real close relationship with his siblings, at least not as close as he did with his mother. So it's possible that his immediate environment wasn't one that encouraged openness about grief. And maybe his father and his siblings internalized their own grief. So in a situation like that, a young person may learn to cope by pushing forward like this. Rather than processing what they've lost, they focus on structure or achievement in responsibility because those things feel safer or more controllable than the grief itself. And in this case, focusing on academic goals is also about meaning to Harold.
- [12:57]
Vanessa Richardson
I'm a big proponent of therapy and, you know, tools for your mental health. But what happens when grief has no outlet, but instead is kept in, kept private, and never really addressed?
- [13:09]
Dr. Tristan Engels
Emotions that aren't expressed or processed tend to become internalized. So like I mentioned, they may appear functional from the outside, but they are often experiencing chronic tension, irritability, or detachment that can affect how they relate to others. Which is why I mentioned that this possibly started with his father and his siblings. If they were all internalizing their grief too, then it's possible that they were all emotionally detaching from each other. And that's not uncommon. If their daily life in the home and their focus was around Harold's mother's care for a period of time, it's quite common and very natural for emotional detachment to occur her after she passed. Their nervous systems were likely just simply worn down from the years they spent constantly worrying about her, caring for her, catering their lives around her needs and her healthcare. And there can also be physical and psychological consequences to holding that in as well. Suppressed grief has been linked to higher levels of stress, anxiety, depression, and even physical health problems. It can also become a distinct diagnosable condition known as prolonged grief disorder. That's when someone's grief has become persistent and disruptive, and the person may experience ongoing longing for the deceased, emotional numbness, avoidance of reminders, or a sense that their identity or purpose has been altered by the loss. And when those reactions last for an extended period, typically a year for adults or six months for children, and it begins to interfere with daily functioning. It can meet criteria for prolonged grief, and at that point, specialized treatment is indicated.
- [14:52]
Vanessa Richardson
Well, Harold's unprocessed grief may have been holding him back. The following year, in the summer of 1964, he sat for his A level exams, but his results weren't Strong enough to get into the program he wanted. It was a harsh blow to his ego and a reality check about how demanding the medical field was. That fall he tried again. He retook the exams and this time he passed. Leeds accepted him for the following year. Even better, he qualified for a grant that would cover most of his expenses. Harold's future finally held some promise. That September, the 19 year old boarded a bus to Leeds, about two hours away, carrying his mother's hopes with him. However, Harold had no idea that life had something else in store for him. Shortly after moving to Leeds, he met a young woman named Primrose. They rode the same bus in the morning. Once they finally gathered the courage to talk to each other, it wasn't long before they were dating. Primrose was Harold's first girlfriend and their relationship moved quickly because pretty soon she found out she was pregnant. Their families were shocked, but because of their somewhat conservative beliefs, the young couple was expected to get married and raise their child together. So that's exactly what they did. Primrose quit her job to stay home and take care of the baby. Meanwhile, Harold stayed in school and returned home every evening to help her out. He managed to keep his grades up, but as time passed and he got to know his classmates better, Harold started to feel like he was missing out on student life. While his peers went out to the pubs after a long day of classes, he had to go home and be a husband and father.
- [16:37]
Dr. Tristan Engels
Late adolescence and early adulthood are usually periods of exploration. People are figuring out who they are, forming their identities, what they value, what kind of relationships they want, and what direction their lives will take. At that age, again, the frontal lobes are still developing. They don't fully develop until age 25. And that's the part of the brain responsible for planning impulse, control and weighing long term consequences. Because of that, young people often make major life decisions based more on immediate circumstances or emotions rather than a full cost benefit analysis of how those choices might affect their future. So when someone in that developmental stage is suddenly placed into a fixed adult role, like a spouse or parent, even if it was initially their choice, that period of exploration can become much more limited for them. And the reality of those responsibilities may be difficult to fully process. At that age, that can lead to different emotional reactions or outcomes, with some adapting very well to that and some feeling resentful and restricted by it. It can also influence how someone views relationships and control. And with Harold, I can see how it could easily turn into resentment for him because at a minimum, he went to school heavily focused on achieving a goal to appeal his mother's last wishes. It was meaning in the name of grief, almost an internalized mandate for himself. That is a lot of self pressure that can create a coping style that leans toward control structure and self reliance because those are the strategies that helped him manage the earlier pain and instability. And now he has created a life that requires him to center his obligations away from that and onto his family.
- [18:28]
Vanessa Richardson
On the outside, Harold looked like a responsible young man, but but on the inside, he felt isolated and confined. When he finally graduated in 1970, he had no time to celebrate. He had a family to support. Becoming a doctor was no longer just a personal goal, it was a necessity. So he chose to spend the next chapter of his career in a small town about 20 miles from Leeds where there were fewer distractions than in the city. There he completed his mandatory year long supervised training at a local hospital. All recent med school grads were required to do this. It was an important part of developing on the job skills in a safe way. But Harold learned a unique lesson during his hospital placement and it was anything but safe. His main takeaway was how easy it was to work independently in a small hospital. Since they weren't as well staffed, there was less oversight, which meant Harold could make a lot of his own decisions. So when it was time for him to land his first official job, he decided he wanted to maintain that same level of freedom. However, what he did with that freedom may have been the beginning of a deadly downhill spiral.
- [19:49]
Hank
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- [20:46]
Dr. Tristan Engels
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- [20:53]
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- [21:00]
Vanessa Richardson
by the mid-1970s, Dr. Harold Shipman was firmly in his 20s. He'd just completed his mandatory job training and was supporting his wife Primrose and their young child. Through his training, Harald had learned that working in a small practice offered a lot of freedom on the job. And he liked knowing that no one was looking over his shoulder. So Harold moved his family to the small town of Todmoden where he worked as a general practitioner in a group practice. He was one of the youngest doctors there, fresh out of medical school with new techniques and up to date training to offer. Todmudden was a small town where doctors were trusted figures and Harold leaned into that role. He worked long hours and volunteered for extra responsibilities. To his patients he came across as conscientious and committed. Even though he had a lot on his plate, he also had something he'd never had before. Total freedom. And with that freedom, Harold did the unthinkable. On the evening of March 17, 1975, Harold arrived at a modest home in Todmudan for a house call. His patient was 70 year old Eva Lyons. Eva was confined to her bedroom suffering from esophageal cancer. When Harold arrived, he found Eva sitting upright in bed with her husband Dick close by. She already had an IV line in place for pain relief. The image looked a lot like what Harold used to come home to in the afternoons as a teenager when his mother was dying. Harold walked over to Eva, removed a syringe from his medical bag and injected a heavy dose of diamorphine directly into the line. Eva and Dick didn't ask any questions. They had no reason not to trust their doctor. And that was exactly what Harold had been counting on. For the next 30 minutes. He and Dick chatted politely as Eva seemingly drifted off to sleep. Once she was fully unconscious, Harold checked her vitals. Then he calmly turned to Dick and stated plainly that Eva wasn't asleep. She was dead. Dick was shocked. He was so consumed with grief he didn't realize how odd it was that Harold didn't even bother to call an ambulance. And later, when Harold signed Eva's death certificate, he wrote that she died of natural causes. She had been sick. So Dick didn't question this either. No one did. Eva's Family laid her to rest and bid their final farewells. Harold's first murder had gone exactly according to plan, and once he'd done it, he savored the feeling. He wanted nothing more than to be in the presence of death.
- [23:52]
Dr. Tristan Engels
It might seem alarming that he would do this so easily when he's had no known history of violence. But psychologically, behavior like this is usually a result of multiple influences or factors over time. And every violent offender has a first offense. We outlined how Harold's early experiences may have shaped how he understood illness, control, and death. Like he lost his mother during adolescence. He watched her suffer and then saw that suffering end in what appeared to be a peaceful, medically managed way. Experiences like that don't cause violent behavior on their own, but they can influence how someone conceptualizes relief authority, control, and the role of medicine. He might also be feeling a loss of control with his obligations at home, which we talked about previously, which could influence his need to regain that sense of control elsewhere as well. Now he's in the position to offer relief authority and trust. He's also in a small community with very little oversight. We don't know what he's been experiencing, thinking, fantasizing, or feeling up until this point. But we do know that watching his mother suffer, then die peacefully left a lasting impact. He may have been fantasizing about recreating that, and he saw not just becoming a doctor as an opportunity, but possibly Eva and the town of Todmuddin as well. And now that he's finally committed the act without any questioning, any intervention, or even consequence, it only reinforces it. Just like you said, Vanessa, he wants nothing more now than to be in the presence of death.
- [25:28]
Vanessa Richardson
Do you think there's any psychological significance to the fact that Harold used morphine to kill Eva? And was he just trying to put her out of her misery? Or maybe was he somehow drawn back to the way it felt when his mother died?
- [25:42]
Dr. Tristan Engels
Yes, other than the fact that it was likely medically indicated to give her at least some morphine for her condition, which offers plausible deniability for him. But it's also the medication that would have likely been associated with the dignified death that he witnessed with his mother. So this could have been a symbolic repetition of that. But whether she did remind him of his mother specifically is really difficult to say. I do think that it could absolutely have offered emotional or situational similarities that triggered associative memory. And in that sense, another possibility is maybe he had no intention of killing anyone, but seeing her having that association triggered an automatic reaction and response. But I can't say if that means he was simply looking to put her out of her misery. Ethical end of life care involves discussion with the patient and family. It involves clear medical justification and appropriate documentation. Here, Harold gave a large dose of morphine without explanation, without consent, and then declared her dead without following normal emergency procedures. That pattern suggests the act was not about legitimate palliative care, but about unilateral control. All of this suggests to me that on some level, there was forethought and planning and that the behavior appears deliberate rather than impulsive. Because if he cared about Eva's suffering, he would care about her husband's suffering, too, and about her postmortem care as well.
- [27:15]
Vanessa Richardson
Well, after killing Eva Lyons, Harold returned to his life as if nothing had happened and nobody suspected he'd done anything wrong. Days turned into months. A full year passed with no known killings, no visible pattern, and no reason for anyone to question him. His reputation grew and his patients trust in him deepened. But during that same period, something else was taking hold. Harold began injecting himself with pethidine, A powerful opioid similar to morphine that's typically reserved for severe pain. Nowadays it's commonly known by the name brand Demerol. As a doctor, Harold had easy access to it. While he'd never shown signs of substance abuse in the past, his addiction quickly grew. But he could only get his hands on so much of it, and soon it wasn't enough. So Harold began forging prescriptions for pethidine in his patients names.
- [28:12]
Dr. Tristan Engels
His addiction is important to look at in context because I think it reflects both biological vulnerability and psychological factors. We know about his most powerful formative experience with opioids. And we talked about how that classification of medication may have become associated not just with pain relief, but with comfort and emotional resolution. That doesn't mean it caused his addiction, but it likely shaped the symbolic meaning that those particular drugs held for him. Opioids don't just reduce physical pain. They also affect the brain's reward pathway and their emotional regulation systems. For many struggling with opioid addiction, they can become a way to manage uncomfortable emotions by providing a temporary sense of relief or control or escape. There's also the issue of what happens after someone crosses a major moral boundary, which he very clearly did. For some individuals, the internal line between right and wrong can become flexible after a serious transgression like this. So his addiction and the prescription fraud may be a combination of his way of emotionally coping, Access to powerful medications, but also a Loss of his own internal restraint.
- [29:24]
Vanessa Richardson
So, in addition to all the ethical dilemmas obviously at play here, what effects could pethidine have had on Harold's brain function?
- [29:32]
Dr. Tristan Engels
So I already mentioned how it affects the brain's reward pathway. And we are speaking specifically now regarding his abuse and misuse of the drug. Not in terms of someone taking it as medically indicated or as prescribed, but just like any other substance that is abused, he can develop tolerance and dependency, meaning his brain will begin to adapt to the presence of the drug. His body will require the drug and then require more of it to produce the same desired effects that he's chasing. As abuse or dependency continues, the drug can begin to affect cognition and decision making. Opioids in particular can impair attention. It can slow reaction time and reduce mental clarity, which is super important if you're a doctor. It's practicing. They can also affect judgment and impulse control, particularly when someone is using regularly or experiencing withdrawal. There are also emotional effects. Long term use is associated with mood instability, irritability, anxiety and depression, especially as the brain's natural reward system becomes dysregulated from it it they may start to prioritize obtaining and using the drug over other responsibilities like their family or work. With pethidine specifically, there's an additional risk. It can build a toxic byproduct in the body, which can lead to agitation, confusion, and even seizures with repeated or high use. So there are a lot of biological, psychological, legal, and even relational risks with continued abuse of this drug.
- [31:07]
Vanessa Richardson
Well, as Harold took more pethidine, it began to take a toll on him. He started having blackouts, and on one occasion, his wife Primrose found him after he'd passed out in the bathroom. She called one of the other doctors at Harold's practice for help. They managed to revive him, and after that, his colleagues were aware of his alarming health problems. They got to work trying to figure out what was wrong with him. Drug abuse was the last thing on their minds. At first, they suspected Harold had epilepsy. As you mentioned, Dr. Engels, he agreed undergo some tests to confirm whether this was true. And in the meantime, Primrose offered to drive him to work. Each day, however, someone else noticed what was really going on. Several months later, a local pharmacist noticed that Harold had been prescribing opioids at an unusually high rate. The paper trail didn't add up, so the pharmacist reported their concerns to the police. When officers questioned Harold, he remained calm and admitted that he'd made a mistake. He told them he'd been addicted to opioids, but that he was cured now. And he asked if they could all simply move on. But the police weren't willing to do that. They cited Harold for drug misuse and prescription forgery. His colleagues were gutted, but still they were sympathetic. They wanted Harold to seek help and get back on his feet, which is exactly what happened. Instead of facing jail time, Harold was only fined and sent to rehab. He was relieved to not have to go to prison.
- [32:37]
Unknown Advertiser/Voice
Prison.
- [32:37]
Vanessa Richardson
Although he expected the situation to end his career. Harold was wrong about that, though, because he remained on the medical register. Once he completed his rehab program and paid his fines, he could continue practicing medicine. It's unclear why Harold didn't lose his license. It may have been due to a shortage of doctors, weak oversight, or maybe a system that viewed addiction as a private illness, not a public risk.
- [33:04]
Dr. Tristan Engels
I'm actually not surprised by this. I can't really speak for other countries, but in the United States, addiction can be recognized as a disability under the Americans with Disabilities Act. And that's because addiction is recognized as a disease that substantially limits one or more life activities. However, those protections depend heavily on the person's current status and behavior. I've personally seen medical or even mental health professionals who struggled with addiction get placed on probationary status by their employers or licensing boards while they underwent treatment, just like Harold, which is usually part of their internal policies. So if they completed treatment successfully and met the terms of their monitoring, they were often able to retain their license and return to work. But again, that depends on the circumstances surrounding it, like the individual's conduct, compliance, and concern for patient safety. That's very different from a situation involving repeated criminal behavior. With Herald. They don't know about Eva. They only know about his addiction. So this is also where something called the halo effect can come into play. That's when positive impressions in one area, like Harold's intelligence, his skill or professionalism, spill over into other areas, leading people to assume that he is ethical or trustworthy. Institutions may minimize or even rationalize concerning behavior because the individual seen as competent, valuable, or high performing. Unfortunately, though, when those biases override objective concerns, it can allow serious problems to go unaddressed. And the consequences can be devastating.
- [34:49]
Vanessa Richardson
Harold had learned something crucial. Even when he crossed a line, the system would protect him from the worst consequences. And with his record quietly tucked away, he moved forward seeking new work and even more autonomy. Me, he never returned to the practice in Todmudden. Instead, he and his family moved to Hyde, a town near Manchester in 1977. There, Harald joined a family practice, once again working alongside other doctors. On paper, there were safeguards, but in reality, a lot of his work was still conducted through home visits and private consultations. Harold had plenty of one on one time with his patients, who were mostly elderly with women. For a while, he played by the rules. He offered genuine care and stayed out of trouble. But then, in 1978, darkness took hold of Harold once again. And this time it overpowered him completely. If you're drawn to true crime stories about disappearances, there's a new crime house show for you to check out. It's the new Crime House original series, the Final Hours, hosted by Sarah Turney and Courtney Nicole. Sarah is an advocate for missing and murdered victims whose own sister disappeared in 2001. And Courtney is a true crime storyteller and investigator who witnessed firsthand how crime can change a family forever. Together, they bring lived experience to every case, looking not only at what happened, but what led up to it. Each episode examined the moments just before a person disappears. The routines, the timelines, and the small details that often get overlooked. Because every disappearance has a moment where everything still feels normal. A text that doesn't raise concern, a routine that goes unchanged, a door that closes just like it always has. Until it doesn't. The final hours puts those moments under a microscope, because when it comes to justice, there's no such thing as overanalyzing. Listen to and follow the final hours on Apple podcasts, Spotify, Amazon Music, or wherever you listen. New episodes every Monday. By 1978, Dr. Harold Shipman was 32 years old and living in Hyde, England with his wife and child. And he was hiding so some dark secrets. He had already killed his first patient and gotten away with it. He'd also been caught forging opioid prescriptions as a result of his own addiction. But after a brief stint in rehab, Harold was back to practicing medicine. Despite the danger he posed. It had been about three years since Harold had killed evil lions. He hadn't done it again since then. But the thought was always on his mind. And once he got a fresh start in Hyde, Harold let his demons take over. In August of 1978, Harold saw an 86 year old patient named Sarah Hannah Marsland. During their visit, he injected Sarah with a fatal dose of diamorphine. Throughout the remainder of the year, Harold killed three more elderly patients the same way. Two of them were women and one was a man. Harold signed other each each death certificate himself and listed natural causes like heart Attacks as the reason for their deaths, which meant no one had any idea Something nefarious had taken place. With no one the wiser, Harold kept on killing. He allegedly had a slow ramp up over the next few years, Usually killing a few people each year. However, in 1980 and 1982, Harold. Harold didn't kill anyone. He claimed a couple more victims in 1983. Then his violence skyrocketed. Between 1984 and 1989, Harold reportedly killed an average of 10 people each year.
- [38:54]
Dr. Tristan Engels
Serial offenders often show fluctuations on their behavior because their actions are often shaped by a mix of opportunity, Perceived risk, Emotional state, Life changes, and internal justification. So when life becomes more structured or stressful, or even closely supervised, the behavior could pause. When they feel safer or they feel more in control, or they're less likely to face consequences, the behavior often escalates. During that three year gap that harold killed eva, he was struggling with addiction. We talked about the effects that can have on the brain, including the cognitive and psychological impairments. That is enough to completely distract him. He then entered treatment and went through major life changes, including moving his family to a new town. Those kinds of disruptions can reduce opportunity and increase scrutiny, which can temporarily interrupt Offending behavior. But once he moved and he regained his assumed trust as a doctor and regained power in a new community and with the medical board, the balance shifted back in his favor. At least his perceived favor. The lack of consequences Also likely reinforced his sense of control and mastery. And with greater opportunity, the behavior trapped Tragically Escalated as significantly as it did.
- [40:15]
Vanessa Richardson
Do you think these patterns that harold has Suggest anything about his potential motive?
- [40:20]
Dr. Tristan Engels
When we look at the common motives for serial killers that the FBI has identified, the one that seems to fit Harold most closely Is power and control. That said, I think it's an oversimplification to say that he was targeting women who reminded him of his mother in some kind of symbolic reenactment. Only we know he also killed at least one elderly man, and I think the ages ranged as well. So this suggests the pattern wasn't strictly about gender or geriatric populations. Instead, I think the more consistent factor Appears to be opportunity vulnerability and medical context. Home care patients with little oversight Are accessible. They're less likely to be closely monitored, and their deaths may have seemed more medically plausible, and therefore he had plausible deniability. That creates an environment with lower perceived risk. It may also have allowed him to internally justify his actions While still gaining Whatever sense of control or psychological gratification he was seeking.
- [41:23]
Vanessa Richardson
Would you say Harold's murders seemed more calculated, or was he more of an impulsive killer?
- [41:29]
Dr. Tristan Engels
Based on the overall pattern of his behavior that you've described, Harold appears to be more calculated than impulsive. Impulsive offenders tend to act in moments of intense emotion, like anger, fear, or desperation, and without much planning. Their crimes are often more chaotic or reactive or they're tied to specific conflicts. In Harold's case, the murders were carried out in very controlled, professional settings, using medical knowledge and access that allowed him to avoid suspicion. So to me, that again suggests forethought and awareness of how to conceal what he's doing. And again, his selection of victims who are medically vulnerable, Often elderly, but not all, and whose deaths would appear natural Points to strategic thinking. Also. That said, behavior isn't always purely one or the other, because his addiction, stress levels, and changing circumstances may have also influenced the timing of certain acts. But the overall pattern leans more toward more instrumental, calculated behavior rather than impulsive violence.
- [42:42]
Vanessa Richardson
Since the upsurge in Harold's victims, Whatever was fueling him, his choice of victim Seemed intentional. Even though the vast majority of his victims were elderly, There were some as young as being in their 40s and the oldest being in their 90s. Many of them were still active and independent before Harold took their lives. So his victims loved ones always reacted with shock and confusion. Their spouse, parent, or grandparent had gone to the doctor for routine care and never came back. Many of the victims were even found at home by a family member, Seated and fully dressed, Often with one sleeve rolled up as if they were preparing for an injection. Still, as devastated as people were, no one had any reason to think the local family doctor was killing people. Especially since hyde was an old mill to town full of retirees and widows. They were accustomed to loss. Not only that, but the majority of Harold's patients were unharmed, which also may have been a sign that Harold exercised some restraint, because in the early 90s, there was a sudden drop off in his murders. In 1990, he allegedly killed two people. In 1991, he didn't kill anyone. And in 1992, Harold only killed claimed one victim. That year, he did something else interesting as well. In August, Harold opened his own general practice in Hyde. It was just a few steps from the market square and town hall, which made it feel homey and familiar to Harold's patients. Unfortunately, over 100 of those people had no idea that when they walked through Harold's doors, they were entering a death trap. Because his urge to kill kill was ramping up again. Between 1993 and 1994. Harold allegedly killed a total of 26 patients. Then in 1995, he killed 28 people that year alone. He took 30 more lives in 1996 and 37 more in 1997. It was a horrifying number of murders, and Henry Harold worked hard to make sure they appeared unconnected. Back in 1993, he'd computerized his practice and started using medical software called Microdoc to privately store his records There. He tracked patients, symptoms, and timelines carefully and meticulously. However, that sometimes meant rewriting history. The system allowed Harold to change patient records after the fact, which he always did. After killing someone, he sometimes added symptoms like chest pain or sudden decline, and even changed the date and time associated with an entry. Each entry created a backstory, and every edit closed a gap. Harold was manipulating the narrative just in case someone ever asked questions falsified.
- [45:45]
Dr. Tristan Engels
Altering medical records is a significant escalation on top of, obviously, the escalation in murders, because those records are meant to document care, honesty, and professional responsibility. For most clinicians, altering them would create moral conflict. So for someone to do it repeatedly, they typically have to reframe the behavior in their own mind. And that's where deception, control, and self preservation start to intersect. They may begin by telling themselves that the changes are minor, necessary, necessary, or harmless. And those justifications can grow, especially if the behavior goes undetected, which it is he's ensuring that's the case. That's moral disengagement. That's a process when somebody gradually changes the way they think about their actions so they no longer feel they're wrong. This is also an attempt to control the narrative by rewriting the records. He wasn't just covering his tracks. He's shaping the story that others would see if they were to read the them. That can create a sense of power because it allows the offender to manage how reality is perceived, not just by them, but by the colleagues who read it, other medical professionals, in case they do any kind of collaboration or coordination of care investigators and families. And for someone who's motivated by power and control, that would be extremely gratifying for him. And of course, this is also a way for him to cover his tracks and make their deaths medically plausible and defensible, which would make him appear to be be medically ethical in his treatment of them as well.
- [47:20]
Vanessa Richardson
What does this level of manipulation suggest about Harold's mindset at this point?
- [47:25]
Dr. Tristan Engels
I think it suggests that it's highly deliberate, controlled, and an invested level of deception. He created a practice strategically upgraded his record keeping, which isn't entirely unheard of for the time, but it's also very instrumental given what he intended it for. And he was systematically decreasing oversight in any area that he possibly could. That suggests, again, planning and foresight. It also reflects a blend of entitlement and overconfidence. All of this happened after he'd built a trusting relationship with the community through his caregiving role. It's as if he begun to believe that he's indispensable or beyond scrutiny. And as if no one would seriously question him.
- [48:13]
Vanessa Richardson
Well, Harold might have been fooling himself just like he was fooling others. Others? People in Hyde spoke highly of him. They praised the time he took with each appointment, his willingness to make house calls and the personal details he remembered. Harold's waiting list was long. Getting an appointment felt like a privilege. All the while, the Deaths continued, including 72 year old Edith Brady. Edith was twice widowed and deeply involved with her family, especially her grandchildren. She drove herself around town, cut her own grass and trimmed her hedges. Nothing suggested her life was nearing its end. One day, Edith drove to Harold's practice for a routine appointment. She was scheduled to receive a vitamin B12 injection. She'd been there many times before and she trusted Dr. Shipman. Even though she had a few chronic conditions, she was in good shape overall. But Edith. Edith never walked out of her appointment. Harold told Edith's family that he'd entered the exam room and found her dead. He said her death was sudden and most likely peaceful. He told them there was no need for an autopsy. Edith's daughter felt glad that at least her mother hadn't died alone. And she thanked Harold for his compassionate care. Once again, nothing about the death raised immediate alarms. So Harold did something similar again. On the morning of June 12, 1998, 73 year old Joan Melia went to Harold's office. She felt a cold or flu coming on and with a busy summer ahead, she wanted something to fight it off. By that time, Harold had already killed 16 people that year. But Joan had no way of knowing that. Her boyfriend Derek drove her to the appointment and waited for her out there outside. When Joan returned, she said she had pneumonia. Dr. Shipman had prescribed her some medication and recommended she buy some cough drops as well. Derek was confused. Pneumonia was serious. Shouldn't she be going to the hospital? But Joan shrugged it off. They went to pick up her medicine, then Derek drove her home. He said he'd stopped by later that day to check on her. He returned around 5pm and rang Joan's Door. Doorbell. But she didn't answer, so he rang again. And still nothing. Finally, Derek let himself in. He walked into the living room and found Joan resting in an armchair. She was fully dressed with a cup of tea nearby. Derek figured her meds had made her sleepy and she was taking a nap. But when he touched her cheek, it was ice cold. Derek started to panic. He quickly called Dr. Shipman, who said he'd be right over. When he got there, he seemed surprised to see Derek. Even though they just talked on the phone, Harold knew that Joan lived alone. Harold brushed off his confusion and briefly examined Joan. Then he turned to Derek and flatly announced that she was dead. He didn't offer any comfort or condolences. Derek was stunned. Aside from the fact that Harold was so short with him, he couldn't understand what had happened. Just a few few hours earlier, Joan had nothing more than minor cold or flu symptoms, and now she was gone.
- [51:34]
Dr. Tristan Engels
Derek was likely in emotional shock from that kind of sudden loss. It was so unexpected that he was trying to make sense of what happened. And because of that, he was in disbelief or denial rather than in critical thinking mode. Intense emotions, narrow attention and can cause people to overlook details that would normally stand out or accept explanations without much questioning. Simply, they're emotionally overwhelmed. In that moment, the loss becomes the central focus, not the circumstances. And that's likely been working to Harold's advantage through most of his killings. In addition to the assumed authority and trust he has by virtue of his profession and the relationships he's built in the community, which is clearly very performative,
- [52:22]
Vanessa Richardson
what do you think it suggests about Harold's motives and plan that he was surprised to see Derek at Jones House? Even though Derek was the one who called him, he obviously knew that Derek was there. Was this maybe another way that Harold was trying to manipulate Derek and make him feel uncomfortable as a way to kind of fool him in the moment?
- [52:41]
Dr. Tristan Engels
I think that means Harold had an assumption of isolation and full control, and Derek's presence actually wasn't anticipated. Offenders who rely on control often imagine events unfolding in a very specific way. Who will be there, what will be said, how the scene will look. They play it out. And when something falls outside of that expectation, it can disrupt that sense of control for them, at least momentarily. So I think this points to how routine and normalized the behavior may have become for him. If he was accustomed to dealing with his victims who lived alone, and most of them did, he may not have considered the possibility of somebody else being present when he was there or even when the circumstances suggested it, or even when they had loved ones and friends who lived nearby, which most all of his patients likely did. And I think his dismissive and calloused response to Derek could have been partly irritation as a result of this, or because he's emotionally detached and he's focused on the task. Or maybe both of those things.
- [53:50]
Vanessa Richardson
Harold may have been confident in his ability to trick deep people. By now he'd gotten away with killing roughly 200 of his own patients for seemingly no reason other than to watch them die, and nobody had a clue. But what Harold may not have realized was that after killing Joan Melia, he'd only claim one more life because he was about to make a crucial mistake, one that would leave behind a haunting clue. Soon someone would put the pieces together, and once they did, the town of Hyde would learn they'd been putting their trust in a monster all along. Thanks so much for listening. We'll be back next time as we discuss the investigation into Dr. Harold Shipman.
- [54:54]
Dr. Tristan Engels
Serial Killers and Murderous Minds is a Crime House original Powered by Pave Studios. Here at Crime House, we want to thank each and every one of you for your support. If you like what you heard today, reach out on all social media rimehouse and don't forget to rate, review and follow Serial Number Serial Killers and Murderous Minds wherever you get your podcasts. Your feedback truly makes a difference.
- [55:17]
Vanessa Richardson
And to enhance your listening experience, subscribe to Crime House plus on Apple Podcasts. You'll get every episode of Serial Killers and Murderous Minds ad free, along with early access to each thrilling two part series and exciting bonus content. Serial Killers and Murderous Minds is hosted by by me, Vanessa Richardson and forensic psychologist Dr. Tristan Engels and is a Crime House original. Powered by Pave Studios. This episode was brought to life by the Serial Killers and Murderous Minds team, Max Cutler, Ron Shapiro, Alex Benedon, Lori Marinelli, Natalie Pertzovsky, Sarah Camp, Sarah Batchelor, Ines Renike, Sarah Tardif and Carrie Moore Murphy. Thank you for listening. Close your eyes, exhale, feel your body relax and let go of whatever you're carrying today. Well, I'm letting go of the worry that I wouldn't get my new contacts in time for this class.
- [56:21]
Dr. Tristan Engels
I got them delivered free from 1-800-contacts.
- [56:23]
Vanessa Richardson
Oh my gosh, they're so fast. And breathe. Oh, sorry. I almost couldn't breathe when I saw the discount they gave me on my first order.
- [56:31]
Dr. Tristan Engels
Oh, sorry.
- [56:32]
Vanessa Richardson
Namaste. Visit 1-800-contacts.com today to save on your first order. 1-800-contacts hi it's Vanessa. If you're drawn to true crime stories about disappearances, check out the new Crime House original the Final Hours, hosted by Sarah Turney and Courtney Nicole. Listen to and follow the Final Hours on Apple Podcasts, Spotify, Amazon Music, or wherever you get your podcasts. New episodes drop every Monday.
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