The idea that a person might suddenly snap and slaughter large numbers of people has become part of our cultural understanding through events such as the Columbine High School massacre and the D.C. Sniper case. But this image of the sudden turn from ordinary citizen, quiet neighbor, or non-descript teenager to mass murderer is generally false. People who go out one day and kill innocent people or supposed enemies have typically thought about it, planned it, and even mentioned it to others before they actually do it--and the act is usually the result of a buildup of stress and frustration....

In 2004, Charles Cullen was arrested and charged in the deaths of more than 30 patients in his care. Crossing several jurisdictions in seven counties in New Jersey and Pennsylvania, he was stopped after a fifteen-year spree at ten institutions. While many people do not think of healthcare workers as serial killers, their profession is disproportionately represented among the serial killer population, and they tend to be more prolific than other serial killers, having more opportunities, better cover, and easy alibis. Healthcare professionals who kill have learned how to exploit the...

The idea that a person might suddenly snap and slaughter large numbers of people has become part of our cultural understanding through events such as the Columbine High School massacre and the D.C. Sniper case. But this image of the sudden turn from ordinary citizen, quiet neighbor, or non-descript teenager to mass murderer is generally false. People who go out one day and kill innocent people or supposed enemies have typically thought about it, planned it, and even mentioned it to others before they actually do it--and the act is usually the result of a buildup of stress and frustration....