ARAPAHOE COUNTY — Denver Post reporter Jordan Steffen’s updates from Day 27 of the Aurora theater shooting trial at the Arapahoe County Justice Center in Centennial, Colorado.
Day 27
Prosecutors are expected to call Dr. Jeffrey Metzner to the stand on Monday as the Aurora movie theater trial moves into its 27th day.
Metzner was one of two court-appointed psychiatrists to evaluate James Holmes after he pleaded not guilty by reason of insanity. Arapahoe County District Attorney George Brauchler has previously told the jury that Metzner found Holmes was legally sane when he killed 12 people and wounded dozens more in the Century Aurora 16 theater.
Metzner completed the first court-ordered evaluation of Holmes. But District Court Judge Carlos Samour ordered a second evaluation in February 2014 after prosecutors accused Metzner of having an “unfair bias” that influenced his findings.
The second court-appointed psychiatrist, William Reid, was called to the stand on May 28. Reid made video recordings of the 22 hours he spent with Holmes in the summer of 2014. All 22 hours of video were shown to the jury.
Holmes could face the death penalty if he is convicted.
The trial is expected to resume around 8:40 a.m.
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LIVE STREAM:
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9:24 a.m.
Before the jury was brought into the courtroom on Monday, defense attorney Kristen Nelson asked to exclude some statements Holmes made to Metzner during his evaluation.
Nelson objected to any testimony by Metzner about Holmes’ statement that he is a “bad shot.”
She also objected to any statements in which Holmes talked about what happened inside the theater and diverting people to the apartment so that he could “kill more people.”
In his report, Metzner discusses Holmes’ religious history. Nelson objected to that information being revealed to the jury.
Holmes also told Metzner that he continued to have homicidal thoughts. Nelson said that statement is similar to a portion Reid’s interview that was not shown to the jury. She also objected to any statements about Holmes requesting an attorney after the shooting.
The last statement Nelson objected to involved Holmes telling Metzner that he does not care about the death penalty because there is “no reason to live.”
District Attorney George Brauchler told the judge he believes the statements should be admitted because similar statements were admitted during Reid’s testimony. He does not have a problem with excluding Holmes’ statements about requesting an attorney.
But Nelson said Holmes’ statement that he continues to have homicidal thoughts is different than Reid’s testimony that Holmes still believes the “delusion” that he can gain value by killing others.
After listening to the arguments, Judge Carlos Samour Jr. ruled that — like Reid — Metzner may only testify about whether Holmes had the capacity to know the difference between right and wrong. Metzner may not talk about the fact that the judge found his report was incomplete and inadequate — which is why Samour appointed Reid to do a second evaluation.
Samour told Nelson that “it would have been nice to get this earlier.”
“I’ve issued hundreds of orders in this case. I’ve made thousands of rulings in this case,” Samour said. “This should have been raised.”
Presenting the objections the morning before Metzner is called makes it “difficult on the court,” Samour said. He said he does not have the ability to review Metzner’s 69-page report or a previous, lengthy order that has already addressed some of the issues.
“Even if it had been raised on Friday it would have given me a little bit of time to do that,” Samour said.
Samour said he has previously thought about what should be redacted in Metzner’s report.
He ruled that Holmes’ statement that he was “a bad shot” will be allowed. Holmes’ statements about what happened inside the theater will also be allowed.
“To me this is necessary for an expert to be able to opine on sanity,” Samour said.
Samour sustained Nelson’s objection to introducing statements about Holmes’ religion. The statements have little probative value and could be inflammatory, Samour said.
Holmes’ statement that he continues to have homicidal thinking will be admitted and Metzner may testify about them. Statements that Holmes feels remorse will not be admitted, Samour said.
“This was a close call for me,” Samour said.
If there is a sentencing hearing, statements of remorse may be inadmissible, Samour said.
Metzner will not be allowed to discuss any of Holmes’ statements about requesting an attorney, Samour said.
Statements that Holmes is not concerned about the death penalty will not be shared with the jury.
After that the judge asked to bring the jury into the courtroom.
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HIGHLIGHTS:
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9:46 a.m.
After the jury was brought into the courtroom, Brauchler called Metzner to the stand.
Metzner carried his briefcase up to the stand. After being sworn in he pulled a heavy file out of the briefcase and placed it in front of him.
The judge gave the jury an instruction as to how they may consider Metzner’s testimony in their deliberations of whether the defendant was legally sane in July 2012.
Metzner was appointed to perform the evaluation through the Colorado Mental Health Institute at Pueblo.
Metzner went to the University of Maryland medical school, where he graduated in 1975, he said. He then came to Colorado, where eventually he began treating people who had been determined to be not guilty by reason of insanity or incompetent to stand trial.
He later became a certified forensic psychiatrist. Metzner is licensed to practice in four states. He also teaches at the University of Colorado.
Similar to Reid, Metzner explains how doctors should be careful when applying clinical diagnoses to legal standards. Metzner helped draft the guidelines for how to complete a forensic sanity evaluation, he said.
Most of Metzner’s work today focuses on mental health services in jails and prisons. He works predominantly for the federal court system, he said.
He speaks with thousands of inmates to evaluate the clinical work being done in prisons. He has treated thousands of people, he said.
The bulk of Metzner’s published work focuses on people with serious mental illness in prisons and jails. Metzner has done hundreds of sanity and competency evaluations in Colorado, he said.
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10:20 a.m.
Metzner has lost count of the times he has been admitted as an expert witness in criminal trials. He has testified during criminal cases in several states. He has also testified in federal courts and he has been mentioned in an opinion handed down by the Supreme Court of the United States.
More than half of the sanity evaluations Metzner has completed were court-appointments, he said.
He has found and testified that some criminal defendants were legally sane. He’s also found that some defendants were legally insane.
Samour granted Brauchler’s request to admit Metzner as an expert witness. The judge then gave the jury an instruction about how they may consider the testimony of an expert witness.
In clinical psychiatry, one of the goals is to establish a therapeutic relationship with the patient, Metzner said. The ethical duty, in that instance, is to do what is in the patient’s best interest.
A forensic psychiatrist does not have such a relationship with the defendant, Metzner said.
“I am not your doctor,” Reid said.
The approach is very different while doing a sanity evaluation, he said. Face-to-face interviews are as important as gathering information from other sources, Metzner said.
Metzner was appointed to do Holmes’ evaluation in April 2013, he said. He wrote a 128-page report.
The first thing Metzner did was review the court order to determine what he was being asked to do.
The standard for sanity involves multiple steps. The first test involves determining if the defendant had a mental disease or defect at the time of the crime. State law defines what a “mental disease or defect” is, he said.
The second test is whether the defendant’s mental disease or defect prevented them from having the capacity to distinguish the difference between right and wrong.
Defense attorney Dan King objected when Metzner began explaining the legal definition of sanity. After a short bench conference, the judge told the jury to ignore Metzner’s last answer and reminded the jury that the judge is responsible for explaining the law to the jury.
Samour also reminded the jury that the prosecution has the burden of proving that Holmes was legally sane at the time of the shooting.
Brauchler asked Metzner to explain how he approaches a sanity evaluation.
Metzner said he looks to see if a defendant lacked the capacity or had the capacity to tell the difference between right from wrong.
In Holmes’ case, attorneys provided Metzner with evidence in the case. He received thousands of pages of documents and videos of Holmes in his cell at the Arapahoe County jail.
Metzner also received all the medical records of the victims, as well as 911 calls from the theater.
“That was a little overwhelming initially to get that much material,” Metzner said.
It is the most information he’s ever received in a sanity evaluation, he said.
After reviewing the evidence, Metzner reached out to both defense attorneys and prosecutors.
Metzner was given a transcript of the preliminary hearing. He asked both sides to highlight things he should be sure not to miss. He also asked what their concerns were.
e reviewed interviews with Holmes’ classmates and any mental health professional who treated or evaluated him. Those were important because they saw Holmes around the time of the shooting.
Metzner interviewed Holmes for the first time on Aug. 7, 2013.
Metnzer spoke with Dr. Lynne Fenton and doctors who saw Holmes at Denver Health Medical Center in November 2012.
Prior to his first interview with Holmes, Metzner spoke to all of the mental health professionals who saw Holmes, including an expert who was hired by the defense.
He also spoke to the defendant’s parents.
“His parents obviously knew him the longest,” Metzner said. “They should be able to provide a lot of information around his mental state.”
Metzner reviewed all 55,000 pages of discovery. After his evaluation he has reviewed an additional 40,000 pages. Metzner found that some statements in the first set of documents were inaccurate, he said.
The notebook was a very important piece of information that Metzner used to help structure his overview with Holmes. Metzner spent more than 100 hours preparing for his interview with the defendant.
He saw Holmes four times in August 2013 at the state hospital. He spent a total of 25.5 hours with him.
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10:30 a.m.
Metzner does not video record his interviews during sanity evaluations. He said it is difficult to get recording devices into jails, where he usually meets with defendants.
In Holmes’ case, Metzner said he wanted to follow his usual techniques. He also said he’s experienced technical problems while using recording devices.
Metzner does use voice recognition software. He has also developed his own shorthand that he uses when he interviews someone.
Periodically he will stop an interview, and will dictate what was just discussed to the computer. It is not uncommon for a defendant to correct Metzner or ask to expand on something.
“That style works for me,” Metzner said.
Metzner keeps his notes after writing the report. Each forensic psychiatrist has a different style, he said.
The Google chats between Holmes and his former girlfriend were important in Metzner’s ultimate opinion of Holmes’ capacity. Holmes’ text with a different woman were also important.
The judge then released the jury for a morning break.
After the jury was out of the courtroom, Samour made additional comments about rulings he made earlier Monday morning.
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11:13 a.m.
After the morning break the jury was brought in and Brauchler continued questioning Metzner.
Metzner went “line-by-line” through the notebook with Holmes.
The defendant cooperated with Metzner, but he found it difficult to get Holmes to expand on his answers.
“Sometimes I got more information. Sometimes I got ‘I don’t know,'” Metzner said.
Metzner said he never saw Holmes crying or grimacing.
Psychological and neurological tests were done on Holmes at Metzner’s request. He said he does not think Holmes was faking an illness.
Metzner looks for a serious mental illness in defendants. Serious mental illness involves psychotic features, he said. Typically it’s someone who struggles to tell the difference between what is real and what is not real.
It may involve someone who has a delusional belief or hallucinations. Serious mental illness may include a thought disorder, such as disorganized thinking and writing. Motor abnormalities are another thing Metzner looks for, meaning people who move around too little or too much.
The fifth area Metzner looks for is “negative symptoms.” Those include a lack of response, someone who doesn’t talk a lot or someone who lacks motivation to do things that they used to.
“By definition if you have a delusion you’re psychotic,” Metner said. “You’re either delusional or you’re not.”
Metzner said Holmes had a delusion that didn’t fit into the normal categories.
Someone can have a depressive disorder with psychotic features or without them, Metzner said. A depressive disorder could make it hard for someone to get out of bed or have a hard time focusing.
Metzner determined that Holmes had a delusion in July 2012.
His delusion was that he would increase his self worth by killing people. The worth that each person had would be transferred to Holmes and would increase his worth, Metzner said.
A second part of his thinking was that if he could increase his worth he would feel less depressed and he would feel better, Metzner said. Holmes “tried” to quantify how his self worth was increased.
Holmes told him that different people have different worth. A surgeon is worth more than a custodian, under Holmes’ calculations, Metzner said.
Holmes told Metzner that children probably had more worth because they had a long time of life ahead of them, Metzner said.
The phrase “human capital” came up after Metzner asked a leading question about the notebook. Holmes was “hopeful” that if he increased his self worth it would result in him feeling less depressed, Metzner said.
“But for the delusion he would not have done what he did,” Metzner said.
That does not affect his capacity, because the definition of capacity is very narrow and does not include causation, Metzner said.
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11:35 a.m.
Metzner attempted to do a differential diagnosis of Holmes, in which he tried to “narrow down” to different disorders Holmes may have.
Metzner considered whether Holmes was schizophrenic, schizoaffective disorder, schizotypal personality disorder or social anxiety disorder. From there Metzner determined that the most likely disorders were a social anxiety disorder, schizoaffective disorder and one more.
None of those disorders mean that someone is automatically considered legally insane, Metzner said. In general, to meet the legal criteria of insanity, someone will have a serious mental illness associated with psychotic features.
Most people with serious mental illness don’t meet the definition of legal insanity, Metzner said. It doesn’t make a difference whether the disorder is schizophrenia, schizoaffective disorder or schizoaffective disorder because they don’t fit the narrow definition of legal insanity — specifically in how they affected Holmes’ ability to function.
Those three disorders do not affect everyone the same way, Metzner said. He likened it to people with diabetes. Some can control the disease simply by monitoring their diet, but others often require hospitalization.
As part of his evaluation of Holmes’ capacity to tell the difference between right and wrong, Metzner considered whether Holmes knew that what he was doing was legally wrong.
Holmes made it clear to Metzner that he knew killing people inside the theater was against the law.
“A lot of his actions you don’t need to be a forensic psychiatrist to come to the same conclusion,” Metzner he said.
The planning was “well thought out” and well documented in the notebook, Metzner said. Holmes told Metzner that he researched the shooting at Columbine High School to determine how long it would take police to respond. He also researched the amount of ammunition that was used in that shooting.
A Google chat with his ex-girlfriend in March of 2012 showed Holmes discussed knowing that police would respond. His dating profiles ask the question: “Will you visit me in prison?”
Holmes posted that before he mailed his notebook to Fenton.
The incendiary devices were set up with the hope that police would be diverted from the theater, Metzner said. That shows that Holmes knew police would be involved and if he delayed them he could “kill more people and increase his worth.”
Holmes never told Metzner that he thought he would wound people instead of kill them, he said.
Holmes’ texts with a different woman in the summer of 2012 capture Holmes telling the woman he was “Bad news bears.” Holmes told Metzner that did not see the woman again because it would be bad for her to have “media exposure.”
The body armor was an attempt to protect himself from law enforcement, Metzner said.
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11:52 a.m.
Metzner also considered whether Holmes also knew that what he was doing was morally wrong.
In the Google chats with his ex-girlfriend, Holmes tells her that what he was thinking about was
“evil.” At that time, in March 2012, he had the capacity to distinguish right from wrong.
Holmes discussed with his friends that killing someone he knew would be too personal.
Metzner asked Holmes why he called a hospital switchboard before he went inside the theater.
“Last chance to turn back,” Holmes told Metzner. “Doubts I guess.”
Holmes told Metzner that he was listening to techno music so that it “wouldn’t be personal,” Metzner
said.
“So there would not be a connection between me and the victim,” Holmes told Metzner. “It would not be like I was murdering somebody.”
Metzner said those actions and thoughts show Holmes’ psychological attempt to “divorce himself from
considering the morality of that.” But the actions also suggest that Holmes had the capacity to
consider the morality.
He also tried to distance himself from considering morality, including Holmes’ speculation that he dyed his hair to “separate” himself from the person who did the shooting, Metzner said.
Holmes’ statements about killing children was another “key issue,” Metzner said.
Once Holmes was arrested, he asked investigators whether he had killed any children. He later told
Metzner that he asked that question because he saw a poster in the police station that reminded him of children and he was concerned he had killed children.
Holmes told Metzner it was wrong to kill children.
Brauchler asked Metzner about Holmes’ interactions with Dr. Lynne Fenton.
“He clearly did not tell them what was going on in his mind,” Metzner said.
Holmes told Metzner he did not tell Fenton anything because he was worried that they would “lock him up.” Holmes never told Fenton that he had a specific target in mind and he did not tell them that he had been buying weapons.
Instead, Holmes told Fenton and another doctor about his plans after he dropped out of his graduate
program. He told them that he was going to stay in his apartment, Metzner said.
The notebook also showed why Metzner thinks Holmes had the capacity to tell right from wrong, Metzner said. Holmes said he sent the notebook to help psychiatrists in the future to better understand “someone like him.”
“If you had lost the capacity to know right form wrong that would have meant that you didn’t think that
what you were doing was wrong,” Metzner said. “I think Mr. Holmes was very angry at Dr. Fenton.”
Metzner said Holmes was mad at Fenton for “what she didn’t do,” he said. He was also mad at the mental health profession.
Holmes went into neurosciences to help figure out what was “wrong with his brain” and try to fix it.
That didn’t work. Fenton didn’t fix his brain and Holmes was very angry with her, Metzner said.
The fact that Holmes told Fenton he was having homicidal thinking shows he was trying to get help,
Metzner said. Having homicidal thinking doesn’t automatically mean that someone can tell the
difference between right and wrong.
Holmes didn’t drive away from the theater. That also suggests to Metzner that Holmes had the capacity to tell the difference from right and wrong.
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12:01 p.m.
Holmes told Metzner that he “did an assessment” when he came out of the theater. He already saw police and he knew that trying to drive away in the body armor “wasn’t going to work.”
“So he stayed there,” Metzner said.
Holmes assessed that there were enough police officers there that he wouldn’t’ get away. Staying was the best choice to ensure he stayed alive, Metzner said.
Metzner said Holmes put his weapon down so he “wouldn’t get shot.”
Holmes took Vicodin before the shooting, Metzner said. He took the medication in anticipation that he would get shot and it would help manage his pain, Metzner said.
In July 2012, Holmes was “very depressed,” Metzner said. He had “lost his self worth.”
Dropping out of school indicated to Holmes that “his brain wasn’t going to be fixed,” Metzner said.
“He was struggling with who he was and what was going to happen to him,” Metzner said.
He had also just lost his first serious relationship, Metzner said.
Brauchler asked if Metzner had a opinion.
“It was my opinion that despite having a mental disability or defect, that Mr. Holmes had the capacity to tell the difference from right and wrong,” Metzner said.
Metzner said he also found that Holmes “did have capacity to form the culpable mental state for the crimes charged.”
Metzner said Holmes met the “criteria for legal sanity,” Metzner said.
After that, the judge released the jury for their lunch break.
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1:47 p.m.
After the lunch break, the jury was brought back into the courtroom and Brauchler continued questioning Metzner.
Brauchler said before the lunch break that he had about 15 minutes worth of questions left. He began by asking what factors he used to come to the conclusion that Holmes had the capacity to determine right from wrong.
Metzner said pages in the notebook detailing his plan and other options besides the movie theater were one example.
“It was very clear that he had thought about this for some time,” Metzner said.
Metzner said Holmes was not floridly psychotic in July 2012. He was floridly psychotic in November 2012 when he was taken to the hospital.
Holmes was psychotic on July 20, 2012 because he was delusional, Metzner said. Still, Holmes was not legally insane.
Being psychotic does not mean that someone loses their ability to be rational, Metzner said.
Holmes told Fenton that he had “prepared enough” for his final exams. But he told Metzner that he normally studied a lot for exams because he was afraid of not doing well. He decided not to do that for his final exam.
Between June and July Holmes went to the theater nine or 10 times to decide which theater would work best, Metzner said.
Holmes told Metzner that he chose to make purchases at stores when it was convenient. He ordered stuff online when it was cheaper.
When he signed up for one of the dating websites, Holmes used an incorrect birthday because he didn’t want to be identified, Metzner said.
Holmes never told Metzner that he was seeing shadows in graduate school. He never mentioned hearing audio hallucinations.
Metzner said Holmes never said he carried out the shooting because he thought the world was coming to an end.
Holmes stopped shooting because his gun jammed, Metzner said. The defendant never told him that he quit shooting because he decided he had shot enough people.
Unlike with Reid, the defendant never told Metzner that he bought weapons out of fear because the screen in his friend’s apartment had been cut.
Holmes never spoke to Metzner about a master power.
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2:22 p.m.
Holmes was medicated when he met with Metzner in August 2013. Those medications appeared to help Holmes be more organized.
In July 2012, Holmes’ thinking was disorganized in how he believed the delusion, but it was organized in other areas, Metzner said. Holmes’ larger purpose for carrying out the shooting was delusional and illogical, Metzner said.
Metzner said Holmes is the primary source of information in determining what his state of mind was at the time of the shooting. He reiterated that there were things in the discovery that were inaccurate.
It’s dangerous to try and render an opinion about someone without meeting them, he said.
King asked wither Metzner would have rendered an opinion without seeing Holmes.
Metzner said it depends on the circumstances.
Metzner asked two other doctors to do psychological and neurological testing. He wanted to make sure his findings were consistent with those results and ensure that Holmes was not faking his symptoms.
He is confident that Holmes is not faking a mental illness. Holmes put forth a valid effort during those tests, Metzner said.
King asked Metzner about his conclusion that Holmes has a serious mental illness. The most likely diagnosis Metzner found is schizoaffective disorder and a social anxiety disorder.
He also diagnosed Holmes with a hair-pulling disorder, but said that disorder has nothing to do with the shooting.
Schizoaffective disorder is less common than schizophrenia, Metzner said. They are both serious disorders.
Metzner agreed with King’s description of schizoaffective disorder as being schizophrenia plus a mood disorder. Those mood disorders can include going through manic states. People can get rapid ideas and have a decreased need for sleep. Depression is another mood disorder associated with schizoaffective disorder.
The judge interrupted King and said they needed to take a break for one of the jurors. A juror submitted a note to the judge that she was going to be sick.
The jury was released for a 20-minute break.
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3:20 p.m.
After the afternoon break, the judge said the juror who passed the note was feeling better.
The jury was brought back into the courtroom and King continued his cross-examination of Metzner.
The diagnosis of schizoaffective disorder was a differential diagnosis, Metzner said. An exclusionary diagnosis is when a diagnosis is ruled out because specific symptoms are present.
There was no indication that Holmes’ psychosis was caused by substance abuse, Metzner said.
Metzner said he saw Reid’s testimony. Reid was asked to read from a book that psychiatrists use to help diagnose people with mental illness.
On Monday, King read from the same cautionary passage that Reid did. The cautionary statement warns psychiatrists of the differences between the clinical diagnoses and the legal standards.
Metzner acknowledged that no one will ever know the thought process of a defendant at the time of a crime. The inference of a defendant’s state of mind at the time of the crime is, in part, based on the diagnosis given.
King then showed Metzner the diagnostic criteria for schizophrenia.
The first criteria is that someone have two or more of psychotic symptoms for at least a one-month period. Holmes met that criteria because he had delusions and negative symptoms in July 2012, Metzner said. If someone has a delusion they are, by definition, psychotic, Metzner said.
Metzner said he is fairly certain that Holmes had a delusion about “human capital” in July 2012.
The second criteria is prior to the onset of the psychosis there are impairments to the person’s function. In Holmes’ case, Metzner found there were significant levels of disturbance in his function at work and in other areas. His break-up with his girlfriend didn’t cause the shooting. Instead, the break-up was one of several triggers to the psychosis that led to the delusion, Metzner said. Another trigger was his struggle in school.
Holmes had homicidal thoughts for years, Metzner said. He tried to figure out what triggered the delusion Holmes held. Metzner said Holmes’ psychosis could have been the “natural course of his illness.” It may have also been triggered by stress.
King asked if Metzner doubted that Holmes was “genetically loaded for mental illness.” Metzner agreed and described the disorders Holmes’ family members were diagnosed with.
Holmes also had negative symptoms before the shooting. Metzner explained that Holmes’ symptoms were active and untreated for at least a month. He also determined that Holmes clearly had negative symptoms for at least six months before the shooting.
Metzner said Holmes’ poor interviews for graduate programs are an example of Holmes’ negative symptoms.
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3:35 p.m.
Instead of studying for his finals, Holmes told Metzner that he decided to “be himself” and not study out of fear.
Holmes’ Google chats with his ex-girlfriend are the first concrete evidence Metzner found that Holmes was psychotic, he said. Metzner said the process was gradual for Holmes.
The psychotic symptoms can increase and decrease over time, Metzner said.
Around the time of the shooting, Holmes’ predominant psychotic symptom was the delusion that he could gain value by killing other people.
Metzner received the writings Holmes did in his cell after he evaluated Holmes, he said.
The portions of the notebook that do not involve planning appear psychotic, Metzner said. He said the writings in the notebook are similar to what Holmes wrote in a Google chat with his ex-girlfriend in March 2012.
“I don’t think she understood what he was talking about because it was psychotic,” Metzner said.
Holmes wrote the notebook after he quit therapy in the summer of 2012.
Psychosis is a severe mental disorder that involves a disconnect with reality, Metzner said.
King asked if everyone who is psychotic is “babbling on the street” and “unable to dress themselves.”
“No,” Reid replied.
Some people who are psychotic are able to plan in great detail over a long period of time, Metzner said. There are people who are psychotic who do need structure and assistance.
“But that is just one end of the spectrum, ” Metzner said.
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3:59 p.m.
A thought disorder is when someone’s thinking is psychotically impaired — their contact with reality is “impaired.”
“What they believe is that it’s real,” Metzner said.
Holmes had other symptoms besides his delusion. That is why Metzner’s diagnosis is different from Reid’s diagnosis of Holmes. Reid testified that he was not certain Holmes had a delusion.
In November 2012, Holmes was both psychotic and suffering from a delirium. He developed a paranoid thought that his bagged lunches were poisoned. He stopped eating and drinking, which caused his delirium.
He was treated for the delirium but he remained psychotic for a period of time. Treatment involved placing Holmes on anti-psychotic medications. Those medications are meant to decrease or stabilize symptoms so he can improve.
Holmes was floridly psychotic in November 2012. Some of his symptoms included spreading feces in his cell, licking the walls of his cell and talking to himself.
Holmes’ ex-girlfriend made the suggestion that Holmes begin therapy. He had reported having thoughts of killing other people for several years, Metzner said.
Similar to Reid’s evaluation, Holmes could not explain to Metzner how he transferred his suicidal thoughts into homicidal thoughts. Metzner said he thinks Holmes’ didn’t understand the thinking.
“There may not be an answer that makes any sense,” King said.
“Correct,” Metzner said.
Next King asked Metzner about psychotic ambivalence. It is an intense ambivalence that “rapidly changes,” Metzner said. Often someone suffers with something as simple as deciding whether to go to the store.
Metzner met with Dr. Fenton. Many of the things Holmes told Metzner were consistent with what he told Fenton, Metzner said.
Holmes told Fenton that he had thoughts of killing people. Fenton recognized “probable psychotic thinking,” Metzner said.
Holmes considered getting glasses as a “betrayal of his biology,” King said.
Fenton never ruled out that Holmes was psychotic, Metzner said.
Schizophrenic people often struggle to explain their delusions after they become medicated.
Five days before the Google chat with his ex-girlfriend, Holmes went to see Fenton. She prescribed Holmes an anti-depression medication. It may also be used for anxiety or obsessive disorders, Metzner said.
Holmes was clinically depressed at the time, Metzner said. Sometimes anti-depressant medications can flip people into manic behavior, Metzner said.
It is possible that the medication triggered a manic episode for Holmes, Metzner said. Holmes’ delusional belief and subsequent actions were not related to the medication.
Holmes got off the medication and those symptoms went away, Metzner said. He would not say that the medication played a significant part, he said.
“It may have played a part,” Metzner said.
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4:18 p.m.
In his text message to a different woman in July, Holmes wrote “Have you ever met someone with dysphoric mania?”
She asks what that is.
“It’s what I’ve got,” Holmes wrote.
Holmes then goes on to tell the woman it’s the reason she should stay away from him. She asks Holmes if it’s “manageable.”
Holmes tells her the “flood gates have open.”
The woman asked if Holmes was OK.
“Yup,” he wrote back.
Metzner said this suggested that Holmes was depressed.
Metzner said Holmes was significantly depressed and he believed that if he acted on his belief he would feel better. Going to jail appeared less painful than continuing to feel depressed, Metzner said.
Before June and July 2012, Holmes had coping mechanisms. One of those mechanisms was school.
“He failed at school. He failed at his relationship,” Metzner said.
Holmes told Metzner that wearing the black contact lenses made him feel “possessed.” The lenses made him feel like he had to go through with the shooting.
Holmes never claimed that a different part of himself was controlling his actions.
He did talk about his “normal self” being different from his “crazy self,” King said.
Metzner said Holmes does not meet the criteria for a multi-personality disorder.
It did appear that Holmes would attempt to minimize his symptoms, Metzner said.
“There’s a tremendous stigma in this country with having a serious mental illness,” Metzner said.
Metzner said there was no indication that Holmes’ mental illness has been a pleasant experience. His mental illness has been “disturbing” for him.
Results from psychological testing done on Holmes revealed that Holmes was not faking his symptoms and was consistent with having psychotic symptoms, Metzner said.
Those symptoms included delusions, hallucinations and catatonic episodes. Also a decrease in function, levels of pleasure, obsessive compulsive behaviors and homicidal thinking. Those symptoms were seen in July and November 2012.
The shooting was a direct result of Holmes’ mental illness, Metzner said. Without Holmes’ mental illness the shooting would have never taken place, he said.
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4:46 p.m.
Someone can believe in moral relativism and still be considered psychotic, Metzner said. The fact that Holmes may have a belief in moral relativism does not mean his thought processes are not psychotic, Metzner said.
Holmes did not react emotionally when Metzner met with him. Metzner was the fifth psychiatrist to see Holmes and the second psychiatrist to speak with Holmes about the attack.
Seeking notoriety was not the basis for the shooting, Metzner said.
King asked Metzner if Holmes had psychotic ambivalence when he saw Fenton and decided not to tell her about his plan. Metzner said he thinks Holmes may have been simply ambivalent but not psychotically ambivalent.
Metzner testified in the case in January 2014. King read from a transcript of that hearing during which Metzner describes psychotic ambivalence and Holmes’ interaction with Fenton.
Metzner said the answer read from the transcript was the same as what he told King on Monday.
During his evaluation, Holmes told Metzner that sharing his thoughts with his girlfriend made them more real. Metzner said he couldn’t “rationally” explain why Holmes felt that way.
“It’s part of his psychosis,” Metzner said.
It was clear to Metzner that Holmes knew that what he was doing was legally wrong. Once he obtained the information he needed, it became clear to Metzner that Holmes had the capacity to know that his actions were morally wrong was well.
King asked if there are circumstances when society considers it morally right to kill. Metzner agreed.
King went on to give Metzner an example. Someone who commits a mass shooting for terrorist reasons would be considered morally wrong by society, King said. But the terrorist may think they are morally right.
Metzner called the example fair.
“It can get a little tough because we’re combining law and morality and medicine in the same place,” King said.
Metzner agreed.
“Reality for that person is colored by the thought disorder they are dealing with,” King said.
Metzner agreed. He gave the analogy of how someone could be intoxicated and know it was illegal to drive while drunk. Someone would also know that it was also morally wrong to drive drunk. But because their judgment is impaired they would still drive.
“Mr. Holmes’ judgment was clinically impaired and that’s why he did what he did … despite having the capacity to know right from wrong,” Metzner said.
It was better for Holmes to go out and “increase his self worth” than to not go out and “feel as bad as he did,” Metzner said.
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5:04 p.m.
King questions how Metzner used a Google chat Holmes had in March to help determine if Holmes lacked the capacity to tell the difference between right and wrong five months later.
Holmes was psychotic in March and he had the ability to form the capacity to know the difference between right and wrong, Metzner said.
Metzner also considered the fact that Holmes did not reveal his plan to Fenton and another doctor when determining that Holmes knew what he was doing was legally wrong. He admitted it was possible that if Holmes had told Fenton his plan, it could have also implied that Holmes knew what he was doing was wrong.
Brauchler started asking his follow-up questions.
Metzner said none of the metaphors provided by King changed his finding that Holmes was able to form the capacity that what he was doing was wrong.
Holmes’ decision to call the hospital, and putting on the headphones before walking into the theater was as close as he could get to knowing what Holmes was thinking at the exact time of the shooting, Metzner said.
The fact that Holmes mailed the notebook hours before the shooting suggested that he had the capacity to know right from wrong. Why would he mail a notebook he thought could help prevent a similar attack? Metzner asked.
Metzner said he does not focus on just a few factors, he looks at the “totality of circumstances.”
Holmes’ delusion was that he would increase his self worth if he killed people and he would possibly be less depressed.
The judge interrupted Brauchler and released the jury for the evening. Metzner will return on Tuesday.
The trial is expected to resume around 8:40 a.m.
Jordan Steffen: 303-954-1794, jsteffen@denverpost.com or twitter.com/jsteffendp
