The Letby Case

Honesty is sometimes used as a way of covering over something far worse

Dear Readers,

If you believe in the value of quality writing and the importance of creating a space for curiosity, critical thought, and meaningful dialogue, your subscription makes that possible.

Join as a paid subscriber to help build a community that values ideas, reflection, and the exploration of what it means to be human.

Since Lucy Letby’s conviction in 2023 for the murder of seven infants and the attempted murder of seven others at the Countess of Chester Hospital, concerns have been raised progressively as to the basis of the judgement against her. At first, a few voices were heard questioning the use of statistics in the medical evidence, and then a chorus of neonatal experts and statisticians who all felt that data had been warped, misused or simply misunderstood. Interpretations of the infant mortalities were challenged, and a press conference in London last week presented all the apparent errors in Letby’s prosecution, pointing instead to catastrophic hospital mistakes, staff acting outside their competence, misdiagnoses of infants at risk, and incorrect use of medical equipment.

As a counterpoint to the controversy over medical evidence, it is claimed that Letby in fact acknowledged her guilt. The interpretation of statistics may have been flawed, but she did write unequivocally “I killed them on purpose because I’m not good enough to care for them” and “I am evil I did this”. Yet such statements – despite being unequivocal semantically – are highly equivocal when we contextualise them, and situate them not just in relation to other statements - “I haven’t done anything wrong” - but to her mental state and possible intentions.

Note that Letby’s ‘admissions’ of guilt were not direct confessions but rather diary entries and notes pinned to a noticeboard in her home. “I am a horrible evil person”, she writes, the “world is better off without me”, “I don’t deserve to live”, “I am an awful person”. Next to a crossed out ”I don’t know if I killed them. Maybe I did. Maybe this is all down to me”, she writes in bold ‘Kill me’.

It was later reported that these statements were the result of a councillor or GP’s instructions to write out what she felt inside, and so were more reflections of her thought processes than descriptions of fact. Journaling is indeed often prescribed when someone is in crisis, as setting one’s thoughts down on paper can in itself be therapeutic.

Whether this was the case for Letby or not, the prosecution also pointed to her apparent fascination with the grief of parents. She would record the birthdays of some of the children who later died – and some who didn’t – as well as the anniversary dates of infant deaths. “I don’t know if many people will think of you today”, she wrote in a notebook on the birthday of one child, and she would search for the families concerned on social media, sometimes swiping from one family to another consecutively. This has been interpreted as a morbid appetite for other people’s grief rather than, say, a concerned and traumatised reaction to loss.

I’m not in any position to give an opinion on Letby’s conviction, but the often hasty reading of Letby’s notes and statements should make us pause to consider how we assess admissions of guilt. Both law enforcement agencies and psychologists are aware of how the clarity of admission may be deceptive. Early in childhood, an open confession frequently hides some secret: when George Washington told his father that he’d chopped down the fruit tree, it may well have been to deflect attention from something else he was guilty of. As adults, honesty is sometimes used in the same way: we admit begrudgingly to some misdemeanour as a way of covering over something far worse.

So an apparently authentic admission of guilt may function as a concealment, just as, at times, it may lack authenticity altogether. Police are familiar with cases where someone walks in off the street to confess to a crime, a situation also found in prisons where an inmate may add a crime to those they have already been charged with. The crimes are almost always those that have received public attention – and, on scrutiny, the person’s involvement turns out to be impossible.

Late nineteenth century psychiatry was particularly interested in cases where patients insisted on their own unfounded guilt, and some were subsumed into the new category of ‘delusions of negation’. They would start by claiming to be responsible for some local tragedy, which would then systematically expand to a culpability for all the world’s calamities. Today, we encounter people who state categorically that they are responsible for the 9/11 attacks in the US, the July bombings in London, the war in Ukraine and even seemingly natural disasters like wildfire and flood.

But there are two very different kinds of admission here. First, those where someone claims to be the culprit of a crime that has received media attention, and it becomes clear that they seek the negative celebrity that this might bring. The admission of guilt here is thus a form of grandiosity; ‘I’m the man who really shot JFK’. But this is totally different from the other cases – those of delusions of negation – where the person does not seek fame but rather punishment. The person berates themselves ferociously and relentlessly, seeking out others who will ratify their guilt and impose sanctions against them.

Reading through the many case reports published in late nineteenth and early twentieth century psychiatric journals, it is remarkable to see that the most common crime which the person accuses themselves of is the death of a child.

Most of the patients in question here were female, and one could speculate that in a time of relatively high infant mortality, what could be more logical than to blame oneself for the loss of one’s child? And especially so given that women are socialised from an early age to turn blame against themselves rather than direct it to others. But in many of these cases, the person accuses themselves for the death not of their own but of someone else’s child. How could this be explained? Sometimes an inter-generational pattern emerged: if a child died in a family, this could touch subsequent generations, as if descendants would have to somehow process the spectre of grief.

The trauma of loss could not be symbolised, and so returned to haunt later generations. Losing a child, after all, goes against the order of things, reversing the natural sequence of mortality. If a mother lost a child, she might accuse herself of infanticide, but a dead child’s sibling or the latter’s subsequent child might also reproach themself for being responsible, with the terrible freight of guilt being passed down from one generation to the next.

These self-accusations – which are unfounded in empirical terms – may form part of the clinical picture of what is known technically as ‘melancholia’. This has nothing to do with the popular sense of the term - which designates a feeling of self-absorbed sadness – but indexes a delusional sense of guilt. Far more common than it might seem, melancholic self-accusation is often masked by long-term alcohol and drug use. When the use of substances stops, the self -reproach often appears as if out of the blue, to the surprise and bafflement of family and friends.

Freud’s initial explanation for this was that the melancholic turns spears into boomerangs, so that an accusation against someone else is turned against the self, a mechanism I’ve explored in detail in ‘The New Black’. The process is triggered initially by a loss – a bereavement, a separation, the end of a relationship or even a close friendship. The person who has experienced the loss then becomes the one they’ve lost, as if they have defended against their grief by keeping the loved one alive in themselves.

The way the person now describes or berates themself really applies to the lost loved one: ‘I’m dead’, ‘There’s no place for me in this world’, ‘I don’t exist’. A mother who has lost a child may feel in her own body the sensations she imagines her child felt as they died: ‘There’s no breath in me’, ‘My heart has stopped’. They have identified with the one they’ve lost. At the same time as remaining alive, they’ve died with them.

But the self-accusation here is complicated. Becoming the lost loved one, the rage at them for leaving may become internalised as a reproach against oneself. A daughter whose late father had been imprisoned for larceny accuses herself of being a thief. Yet the self-accusation can also express a punishment for having failed them in some way – for example, for failing to keep them alive.

After a loss or a death, the person may suddenly feel a sense of destiny, as if they must share the same fate as their loved one. They will die at the same age or time of year, perhaps of the same illness. The feeling of responsibility – even if not fully conscious – means that they are doomed to suffer in the same way. In some cases, if one has narrowly escaped death being born, there may be a powerful sense of fate or retribution, as if one doesn’t have the right to stay alive, a motif exploited in the ‘Final Destination’ movies.

Marie Bonaparte, the Greek princess, psychoanalyst and occasional babysitter of Prince Phillip, had lost her mother to TB when she was barely one month old. She was told that her birth was paid for with her mother’s life. Given the same name, Marie would become convinced that she too would die of TB, and began to mimic its symptoms: she lost appetite and weight, contracted respiratory infections with bloody mucus in her throat. The symptoms perhaps signified both repaying the debt to her mother and a punishment for having caused her death.

And this is where the motif of confession becomes so central. If the person develops a delusional sense of guilt, they hold themselves responsible for the death or calamity. They may either broadcast this self-conviction publicly, erase it through alcohol and drugs, or remain in a strange limbo, as if in a dock awaiting a sentencing that is perpetually on the horizon.

So confessing to a crime is not the same thing as being guilty of that crime. Someone may assume a guilt for a death that they are not in reality responsible for, as no other option seems possible for them. They know they are guilty of something but falsely ascribe the guilt to a crime they had no part in. The more acute the feelings of loss and grief, and the more contingent and unknown the causes of loss might be, designating oneself as responsible may have a resolutive value.