Recurrent suicidal behavior

Charles Cullen’s recurrent suicidal behavior is presented not as a single crisis but as a pattern that began in childhood and recurred through his adult life. Again and again, he made himself ill, staged the appearance of imminent death, or took pills in circumstances where he expected to be found and treated. The episodes brought him into contact with people who would attend to him, even as they deepened the distress and conflict around him.

Early Gestures and the Appeal of Rescue

Cullen’s first suicide gesture came at nine, when he mixed the contents of a chemistry set with milk. The mixture made him sick but did not kill him. His next attempt followed the death of his mother in a car accident in December 1977. After staff at Mountainside Hospital told him she had died and that her body had been taken away, he felt that the hospital had lied to him. The book connects this anger to a lasting distrust of hospitals, while also showing how his mother’s death returned him to self-harm: the episode led to his first hospital stay and first psychiatrist, but he was not yet willing to talk about his pain.

The pattern continued after Cullen joined the United States Navy. He disliked the routine, the orders, and life under the ocean, and repeatedly tried to escape his six-year contract. He was demoted for refusing orders and for increasingly erratic behavior. In his final year, he drank heavily; when alcohol ran out, he turned to Listerine or cleaning fluid. On January 13, 1984, he drank a bottle of cleaning fluid and reported to the sick bay aboard the USS Canopus, telling the medic he had swallowed poison and felt unwell. It was his third suicide announcement since entering the service and his third ambulance trip to the psychiatric ward at Charleston Naval Hospital.

Illness as a Bid for Attention

The book distinguishes Cullen’s repeated suicidal gestures from a settled intention to die. Catholic-school teaching had made suicide a sin, and he feared purgatory; illness offered another way to approach death without crossing that line. As he understood it, nobody loved a person as they did when that person was dying. The ambulance ride and hospital response could briefly give his suffering an audience, while leaving him alive to receive care.

That need for recognition surfaced in his marriage to Adrianne Cullen as a series of staged demonstrations. Cullen arranged for her to find him on the phone with a funeral parlor, asking about burial rates. On another occasion, he flopped onto the living-room floor and spilled prescription pills from an amber bottle, presenting the scene as a suicide attempt. Adrianne stepped over him to pick up a magazine. He gathered the pills one by one, then held on to the hurt of her indifference; his efforts to make her see his pain instead deepened her resentment.

After Adrianne called the police during their separation, Cullen responded by swallowing twenty pills with wine, insisting to himself that this time he was showing her what a real attempt looked like. The episode grew out of the same conflict between display and danger: he experienced himself as wronged and unseen, while the gestures meant to summon care further damaged the relationship. His distress was not merely implied by the acts; he repeatedly arranged for other people to witness them, and their reactions became part of the pattern.

Adult Crises and the Return to Medical Care

In the episode that followed a warrant for his arrest, Cullen tried to make legal surrender and a suicidal crisis happen together. After an officer from the Palmer County Police called, Cullen agreed to report to the station. He took twenty pills—Xanax prescribed after psychiatric treatment and Darvocets he had taken from Adrianne after her gallbladder operation—then drove there, expecting the drugs to take effect while he was in custody. Instead, police processed and released him: they took his fingerprints and photograph but had no intention of keeping him in a cell. Almost incapacitated, he drove away in the rain, pulled over near a motel, and called the babysitter because he could think of no suitable person to contact. He sat waiting for a ride to the hospital. The episode repeats the pattern in altered form: he sought both the consequences of an overdose and the intervention that would keep him alive, but the police station did not provide the audience or rescue he had imagined.

After pleading guilty to harassment and defiant trespass on August 10, Cullen again attempted suicide with pills and wine. He drove himself to Warren Hospital and admitted himself to the emergency room. The act briefly relieved the pressure through the familiar conjunction of deliberate danger and helplessness, but the relief did not last; he was released the next evening and drove home through the fog. His probation also narrowed the outlets available to him: he knew that contacting Michelle Tomlinson would violate its terms, yet felt a need to speak. He wrote to the judge through the night, amid wine bottles and the ticking kitchen clock, turning the unsent or forbidden conversation into a stack of handwritten motions delivered in person the next morning.

Losing his job at Morristown Memorial Hospital revived the cycle. After the hospital review and its board both upheld his termination, Cullen sought outside arbitration, but the slow exchange of letters and faxes did not satisfy him. He called 911 to report that he had swallowed pills, knowing that an ambulance would take him to nearby Warren Hospital, where he was already known. There, the response itself became part of the appeal: paramedics assessed him, attendants checked his vital signs, and he emphasized his identity as a registered nurse by using clinical vocabulary. Yet he also knew that staff saw him as a familiar former employee, a recurring suicidal patient rather than simply a colleague in distress. He hoped Warren would arrange another transfer to Greystone Psychiatric Hospital, where he had previously felt comfortable; the emergency physician required a blood test before deciding what care to recommend. Across these episodes, medical attention could provide a temporary sense of recognition, but each return also made Cullen more recognizable to the institutions receiving him—and did not resolve the distress that brought him back.

The Pattern’s Relational and Institutional Costs

The recurring crises did not remain private episodes between Cullen and the people summoned to care for him. At Somerset Medical Center, a new insulin sign-out procedure made nurses account electronically for the amount left in each vial. Amy Loughren challenged the change, suspecting that something had happened on her unit, perhaps to a patient, but management would not explain why insulin was being treated differently. As rumors spread about Charlie, insulin, and a death, colleagues began avoiding Amy because she was known as his friend and had resisted the new protocol. The episodes of self-harm belonged to a wider setting in which Cullen’s distress, his conduct at work, and questions about patient safety became difficult for others to disentangle.

That entanglement became personal when a detective showed Amy a Pyxis printout from the night Reverend Gall died. She recognized Cullen’s activity and could now imagine that her friend had done something terrible, though she could not reconcile the evidence with the person she believed she knew. Her response was not an uncomplicated turn against him: she had trusted him deeply, and the discovery reopened her longstanding struggle over whom she could trust. The investigation asked her to risk her job, deceive Cullen and her employer, and act on evidence supplied by strangers. She feared the detectives might be wrong or manipulating her, even as the paper made denial harder.

Amy’s cooperation brought its own sustained strain. She pored over records, returned to work to use the Pyxis, and carried information to investigators while fearing dismissal and feeling isolated from the institution she hoped to improve. The account does not present Cullen’s recurrent suicidal behavior as an explanation for his patient killings, or as a crisis that resolves into recovery. Instead, it shows how repeated appeals through illness could coexist with danger to others, while leaving friends, colleagues, and medical institutions to confront the gap between the familiar person seeking care and the evidence of harm.