Dominic Lawson: We should have no reason to be surprised when a doctor turns out to be a murderer

What should a genocidal mass-murderer look like? And what professional qualifications should he have? Of the two men indicted by the Hague war crimes tribunal as masterminds of the planned massacre of thousands of Bosnian Muslim adults and children, Ratko Mladic fits all our preconceptions.

General Mladic was a man drawn to the sound of gunfire from an early age. His is a face that seems to exude brutality. Yet his boss, Radovan Karadzic, does not conform to this stereotype. As this newspaper's former Balkans correspondent wrote this week, he struck his western interlocutors as "amiable and disarming ... quite unlike the effect of a conversation with the screaming psychopathic Mladic".

Karadzic, sorry, that should be Dr Karadzic, was a respected psychiatrist, who trained with our very own Tavistock Centre (he specialised in paranoia, in case you were wondering). He was also a poet, with a number of published collections to his name. Indeed he looked as a poet should look, with sensitive, spaniel-like eyes, and very creative hair.

In fact Karadzic's poetry is so dreadful that it alone would merit indictment by a tribunal – for crimes against literature. Yet it also gives a much clearer insight into the character of a mass-murderer than any of his political statements. One stanza in a poem about Sarajevo is absolutely explicit: "Let's go down to the cities to kill the scumbags." Or try this: "Now that I am in this crazy fervour of mine I could do just about anything/So your stupid rotten vain souls wouldn't stare at me with their stupid peaceful eyes."

The man's raging megalomania is also given free rein in verse: "It is only I who sprouted from the Universe like the morning star/And the Universe blushed with envy and changed colours." So when you see accounts of a two-year-old Bosnian Muslim child impaled on a wooden pole with a sign reading "This is what we are going to do to all Albanians because I am God and Nato means nothing to me," you are almost certainly reading the words of a killer directly inspired by Karadzic's rhetoric.

Karadzic the poet and Karadzic the maniac are thus easily reconciled; but where does that leave Dr Karadzic, the qualified doctor and psychiatrist? We like to think of doctors as people motivated solely by concern for the well-being of all their patients; but it shouldn't take a Harold Shipman – whom Karadzic eerily resembles in his disguise of beard and big glasses – to inform us that this cannot be true in every instance.

If you read Michael Burleigh's Death and Deliverance, an account of how German doctors actively participated in the murder of over 100,000 handicapped people as part of the Nazis' eugenic exercise, then you can not be altogether surprised to learn of more modern medical monsters.

Those German doctors claimed that they were improving the genetic health of their race. Karadzic, like the Nazis, was a believer in ethnic purity, and above all, the innate superiority of the Christian Orthodox Serbs over their Muslim neighbours. He felt the killing of a bumble bee to be more regrettable than the slaughter of any number of Muslims – a distinct echo of the animal-loving Adolf Hitler, who regarded the eating of meat as barbaric.

It is serendipitous that the arrest of Dr Karadzic came on the same day that the British government revealed its plans for an annual audit of doctors, to weed out the bad 'uns. Most of the reports illustrated this story with a photo of the late Harold Shipman. The chairman of the British Medical Association, Dr Hamish Meldrum, observed that "Harold Shipman wasn't necessarily a badly-performing doctor in the sense of his clinical practice, but he was a murderer. We are not really devising a system purely to pick up murderers."

Dr Meldrum speaks with disarming honesty: greater invigilation of medical practice might expose doctors who treat patients rudely or capriciously. What it won't do is find the one-off mass murderer – any more than Sarajevo University Hospital could have detected from Dr Karadzic's medical practice that he would end up consigning thousands of his fellow-citizens to grotesquely imaginative forms of torture, mutilation and death.

Similarly, the American doctors at the Rockefeller Institute in the 1940s could not have guessed that their Haitian colleague Dr François Duvalier, a noted researcher into tropical diseases, would become the terrifying dictator known as "Papa Doc", feared throughout Haiti not just for his murderous militia known as Tontons Macoutes, but also for his claims to semi-divine status – a kind of voodoo Jesus Christ.

A doctor friend of mine who had visited Haiti under François Duvalier's rule had asked himself why it was that while the vast majority of his colleagues in the medical profession were indeed good men and women, that a few developed into truly dangerous people. He came to two conclusions.

The first was that there must be a handful of men who are attracted in exactly the wrong way to the absolute power over life and death that doctors traditionally wield. These doctors often have an exceptionally odd relationship with the opposite sex, as some women find out to their pain and distress; again, Dr Shipman was a very extreme example of this.

His second conclusion was that part of the training of doctors – at least for those of his generation – involved learning how to "steel yourself" against disgust or distress. So they would be required to participate in dissections and autopsies, events which are sickening when first experienced. Indeed, it is essential for all doctors to have a high degree of emotional detachment; when you think what distress is daily witnessed in our hospitals, it would be very dangerous to their own peace of mind to empathise fully with every bereaved family.

However, according to my friend, there will be a handful of doctors in whom this necessary professional detachment mutates into complete indifference or even a form of sadism. Perhaps that is one reason – quite apart from a virulent ethnic hatred – why the good Dr Karadzic was so immune to feelings of pity towards even the children whose slaughter he instigated.

In this context, it is especially revolting that in his disguise as the Alternative Health guru "Dr Dragan Dabic", Karadzic chose to operate under the webmail address of healingwounds@dragandabic.com. Those of us who have long regarded the field of "alternative" therapy as a fairground for medical imposters can however derive some bleak satisfaction from the fact that Karadzic decided to impersonate such an imposter – not just a quack, but a quack quack.

One of "Dr Dabic's" claims was that by the use of "Quantum human energy", he could demonstrate that all humans "are programmed to live to up to 130 years of age". Well, if things go as the prosecutors at the Hague tribunal intend, Dr Radovan Karadzic will never again be a free man, even if he should live to 130.

d.lawson@independent.co.uk