A Dark Night in Aurora

by Dr. William H. Reid

  The prosecution alleged that rage over Gargi’s breaking up with him was a catalyst for Holmes’s shootings. There’s little evidence for that. Datta told of the texts and chats that would later be viewed as premonitory but at the time seemed more like banter, odd to be sure, something that caused her to recommend a therapist, but far from warnings of a future massacre.

  Ben Garcia, probably Holmes’s best graduate school friend, was the one who urged him to ask Gargi out in the first place. Both Ben and Gargi commented on Holmes’s good, if a bit quirky, sense of humor. The three of them hung out with a small group, having dinner, studying, playing board games. Holmes dropped away from the group after he and Gargi broke up. The reasons and process are unclear, but Holmes wasn’t part of the group anymore and, although Ben reached out a couple of times, made no effort to keep the relationships going.

  About five weeks into the trial, the prosecution called Holmes’s graduate school psychiatrist, Dr. Lynne Fenton. Holmes had told her in March of 2012 that he had “homicidal thoughts” up to three or four times a day, but she made it clear to the jury that Holmes refused to provide any details about those thoughts: no targets, plans, or indication that he had bought weapons. She inquired carefully; he purposely withheld the information.

  Holmes never showed signs of depression or mania, she said, and he never described hearing voices or seeing things. She asked about other symptoms, but he didn’t mention the concerns he later chronicled in his notebook: worries about his nose, eyes, and penis, the feeling of “catatonia,” or his odd sense of himself. She sensed that he had some level of hatred for mankind, but, she testified, “he didn’t state that in so many words.” She considered hospitalizing him against his will—he didn’t want to be locked up—but her hands were tied because she had no evidence for the imminent danger legally required for involuntary detention. Her best option was to get consultation from a senior colleague, so she contacted Dr. Robert Feinstein.

  Dr. Feinstein testified just after Dr. Fenton and described much the same experience with Holmes. He had been Fenton’s mentor and a frequent consultant, not unusual in medical school settings; they met often to discuss cases. Feinstein agreed with Fenton that there had been no indications of specific plans, victims, or preparations while Holmes was in treatment. He and Fenton offered an antipsychotic medication, risperidone, but Holmes declined. They considered transferring Holmes to a different psychiatrist, perhaps Feinstein himself, to see if a stronger therapeutic alliance might be forged with a male clinician. He stopped therapy before that could take place.

  Very soon after his final session, Fenton alerted the campus threat assessment team and called Holmes’s mother, Arlene. No one else had any specific information about danger either, and he had quit school and surrendered his campus access cards. From the university’s viewpoint, the matter seemed closed.

  The survivors called by the prosecution continued to relate experiences of terrible fear and trauma, physical and emotional, to the jury. Veronica Moser’s mother, Ashley, now paralyzed from the waist down from one of the four bullet wounds that also led to her miscarrying Veronica’s baby sister, was the last prosecution witness. “I went to stand up,” she said, “to reach for her hand. I felt it slip through my hand. As soon as I stood up, I remember getting hit in the chest.” Then Ashley fell too, unable to move. Her daughter wasn’t breathing. Holmes looked away as she spoke.

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  The prosecution rested its case on June 19. Then it was the defense’s turn.

  14. The Holmes Defense

  “It was like a storm. He tried to get help, but nobody did much about it except tell him that everything would be okay.”

  (Dr. Raquel Gur, testifying about Holmes for the defense)

  The defense case was much shorter than the prosecution’s, with its long line of investigators and the often tearful litany of survivor experiences. Holmes’s defense was developed by a team of very competent lawyers and investigators. Their witnesses’ direct testimony was largely handled by chief trial deputies Daniel King and Tamara Brady, who had also cross-examined many of the prosecution witnesses.

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  The first defense witness was Jason Frank, a nurse from the Arapahoe County Detention Facility. He and other jail staff described Holmes as not particularly unusual until his psychotic break in late November of 2012. The defense played jail video of that episode, with clips of Holmes falling backward from his bunk. They would eventually show the jury video of all Holmes’s unusual, sometimes bizarre, behavior while in custody, including smearing his feces in the BC cell and being naked and restrained in his bed later that month during his treatment at Denver Health Medical Center.

  Then the defense called the first of their two psychiatric experts, Dr. Jonathan Woodcock. Expert witnesses for either side in trials must first be “qualified” by the court in order to opine in their areas of expertise, a legal questioning process called voir dire. The side that calls the expert builds him or her up a bit for the judge; then the opposing side may question the expert’s credentials, experience, or other qualifications. It is unusual for a physician, such as a psychiatrist, to be found unqualified to testify, but the back-and-forth between the lawyers is not lost on the jury.

  The prosecution spent an hour trying to get Judge Samour to rule that Dr. Woodcock wasn’t qualified to be an expert in the Holmes case (or, more likely, trying to weaken his credibility in front of the jury), in part because he had almost no experience in criminal cases. That effort failed, and he testified all day, describing his examination of Holmes just days after the shootings and his opinion that Holmes’s mental illness was so severe at that time that he should be found legally insane.

  Woodcock appeared to have no doubt that Holmes was psychotic during the four days from just before the shootings until Woodcock interviewed him, even though psychosis per se doesn’t preclude an accurate thinking process for planning and carrying out such a “mission.” He found Holmes to be well oriented, organized, and able to communicate adequately just a few days after he was arrested. The psychosis, Dr. Woodcock testified, was defined mostly by the delusional content of his thoughts.

  On cross-examination, DA Brauchler focused on Holmes’s clear knowledge of society’s norms for legal and moral behavior. When Woodcock brought up clinical points, Brauchler said, “But, Doctor, there is no [such thing as] ‘clinical’ insanity, right?” referring to the law’s definition of insanity and psychiatry’s avoidance of that term. His questions were fast and aggressive, criticizing Woodcock’s temporizing and avoiding of simple yes-or-no answers.

  The defense objected vigorously, usually to no avail, on grounds that Brauchler’s questions had already been asked and answered and that they went beyond the scope of Woodcock’s earlier direct testimony. (Courtroom rules require that cross-examination be limited to topics already brought out in direct testimony.) Dr. Woodcock often seemed flustered under Brauchler’s practiced barrage; the judge warned him several times about not answering Brauchler’s questions or inserting comments when there was no question.

  Dr. Woodcock believed that Holmes needed antipsychotic medication as of his (Woodcock’s) July 24, 2012, visit. Cross-examination revealed that jail psychiatrist Erwin Mozer had told Woodcock that the public defender’s office instructed him (Mozer) not to talk to Holmes without their permission, which interfered with his care. Woodcock had shared his impression of severe psychosis with Mozer and told him that antipsychotic drugs would be appropriate, even though defense lawyer King had told Woodcock at the time, in July 2012, not to talk with Dr. Mozer.1

  Dr. Woodcock said that he hadn’t reviewed the case records until the summer of 2014, almost two years after he saw Holmes, at which time the defense asked him to provide psychiatric opinions based on those records and his 2012 interview. He was notified in early 2015 that he would be called to testify, and he submitted a report to the defense in late March without talking with Holmes again. He asked to in
terview Holmes once more and saw him April 1, just before the trial began.

  Woodcock testified that the opinions he gave in court had been based primarily on his single early interview, done at a very opportune time but in which he hadn’t been allowed to ask Holmes anything about the shootings themselves. A defense investigator had been present and interrupted the examination at least twice. Dr. Woodcock’s report and testimony did not appear to consider Holmes’s many written communications prior to the shootings, audio- and video-recorded law enforcement interviews of the defendant immediately after the shootings, and other information that would ordinarily be routine parts of a forensic assessment. I don’t know whether or not the defense ever provided all of those to Woodcock.

  On redirect by the defense, Woodcock noted that the “catatonia” the defense used as an indication that Holmes was psychotic before the shootings wasn’t really there in his interviews; Holmes had misused the term in his notebook. Still, Woodcock testified, there was evidence that Holmes couldn’t control his thoughts or actions after, as Holmes texted to Hillary Allen, “the floodgates opened.” Holmes pursued his mission in an organized fashion, but his goal was determined by his delusional state, he added. In Dr. Woodcock’s opinion, the presence of detailed planning and organization didn’t mean Holmes could control his behavior and didn’t mean he was sane at the time.

  Brauchler’s recross-examination continued as aggressively as before. No, Woodcock agreed, there was no mention of hallucinations or “shadows” during his July 2012 interview. Maybe Holmes saw a “flash” sometime years before the shootings. In the end, Dr. Woodcock’s opinion of insanity rested to some extent simply on his not being able to think of a rational reason for Holmes to kill the people in the Century 16 theater.

  After a few more fact witnesses to bolster the defense position of severe mental illness and try to introduce reasonable doubt about the defendant’s sanity into the jurors’ minds, the defense called Dr. Raquel Gur. Dr. Gur, a professor of psychiatry, neurology, and radiology, had seen Holmes many times since the shootings. She had done complex neuroradiological tests of his brain and had thoroughly reviewed all of the records and expert reports. She spoke with a European accent that might have conveyed sophistication and scientific credibility to some jurors but also might have made her testimony difficult to understand in places.

  At Mr. King’s invitation, Dr. Gur described asking Holmes many questions about whether or not he was angry or vengeful and whether or not the shootings were motivated by anger or hatred. Those were important to eliminate if the insanity defense were to be successful. His answers were consistently no, Gur said. He wasn’t mad at anybody. She appeared to accept his responses at face value. She could find no nonpsychotic reason for the shootings; if Holmes hadn’t been severely mentally ill, the shootings wouldn’t have happened (an opinion held by all the other experts as well).

  “He believed the world was coming to an end,” Gur testified. “We are all going to die … [the] nihilistic thought that there’s no meaning to life.” Holmes told her that he thought he was helping people by shooting them. “Everybody is going to die anyway.” There’s no purpose in life. Life is miserable for everybody. Put them out of their misery.

  According to Gur, Holmes was engulfed in his delusion, and once he described it out loud to Gargi and to Dr. Fenton, the floodgates were open. “He had to do it. He struggled with it for years. It was like a storm. He tried to get help, but nobody did much about it except tell him that everything would be okay.”

  In Dr. Gur’s view, Holmes was already on the way to psychosis early in graduate school. That year, and his experience of the year as a failure, was the last straw. He was doing okay, making good grades, but in his distorted reality he wasn’t perfect. He had trouble learning the laboratory procedures. Something was wrong with him, he believed; he wasn’t at the top of his class anymore. Life was meaningless anyway. “We were dead before we were alive,” Holmes had said, and we would be dead again afterward.

  Gur explained that psychosis is an intrusive experience, bringing into consciousness thoughts and sensations that are usually unwanted and upsetting. Holmes developed ways of distracting himself from those thoughts, with homework for example, computer games, and plucking at his hair. He was doing what he could do to feel better, she said, but doing it secretly, “so people wouldn’t think he was crazy.” Gur diagnosed schizophrenia and compared his thoughts and self-doubts (but not his violence) to those commonly found in other people with the disorder.

  Over time, Gur explained, Holmes’s unwanted thoughts became delusional and evolved as the major force in his life. Some of his delusions became bizarre, she testified, and some were totally irrational. They were unshakable and pervasive, and he still has them today. Gur alluded to Holmes’s intelligence, testifying that when smart people become delusional, they tend to have more bizarre delusions than the average patient: “they think about deeper things.” She compared Holmes to the Unabomber, Ted Kaczynski, “smarter people,” she said, who “tend to elaborate more and write more.” She referred to Holmes’s writings while he was in jail, saying that in her opinion they indicated delusions and disorganized thinking.

  Dr. Gur was the only expert to order magnetic resonance imaging (MRI) of Holmes’s brain. She compared his MRI results to those of some seventy-nine healthy people she had studied in the past and concluded that Holmes had a slight but statistically significant lack of temporal lobe tissue (an area of the cerebrum that sits on the lower sides of the brain and affects, among many other things, personality and processing sensory information). She pointed out on MRI images projected for the jury that his right fronto-orbital area (the top front portion of the brain, roughly behind the lower forehead), important to some emotions, motivation, and inhibiting inappropriate behavior, was lower in volume than that of 99 percent of the general population. His amygdala, deep in the brain and an important hub for nerve cells that mediate emotion, was smaller than that of 95 percent of normal people.

  In short, she testified, Holmes had below-average brain volume in those areas that are important to emotions and decision making.

  Brauchler was just as vigorous with Dr. Gur’s cross-examination as he had been with Dr. Woodcock’s. He couldn’t criticize her methods as much; she had spent many hours with Holmes and tried to put her findings into the context of her substantial clinical and scientific experience. Much of his time was spent picking at little things, such as Gur’s diagnosing Holmes before talking in person with his parents—she already had lots of information from them through other sources—apparently trying to decrease her credibility with the jury. She remained calm and professional under Brauchler’s attack, which one of the local media outlets, the Aurora Sentinel, described as “hammering the defense’s star witness.”

  Brauchler also attacked Gur’s lack of forensic training and experience. She willingly, even proudly, responded that she was not a forensic psychiatrist, but a clinician. (Almost all forensic psychiatrists are also clinicians; the two are not mutually exclusive.) She acknowledged that she was not Board certified in any of her specialties, a bit surprising since such certification is an almost ubiquitous credential for medical academicians, clinicians, and forensic physicians. He pointed out that she had testified in court only twice, both times for the defense.

  He highlighted inconsistencies in what Dr. Gur related as Holmes’s statements and his statements to other evaluators. Some were significant, but others were explainable in terms of simple differences in the interviews or memories changing a little from month to month. Brauchler inflated them for the jury; Gur parried his barbs calmly but not always effectively. For example, Gur, whose interviews were not recorded, agreed that her report quoted Holmes as describing “a call to action.” No one else ever heard him say that, and he denied ever using those words. Brauchler pointed out that the phrase was also the title of a book chapter Gur had written years before. Dr. Gur scoffed at the comparison and said the two r
eferences were completely unrelated.

  The defense explored, but did not use in court, another line of defense: an attempt to indict the antidepressant and antianxiety medication that Dr. Fenton had prescribed for Holmes during the spring of 2012, sertraline (Zoloft).

  A handful of small studies based on anecdotal reports, generally contradicted by the bulk of the psychopharmacology literature, suggest that sertraline and similar antidepressants (selective serotonin reuptake inhibitors, or SSRIs) can precipitate or worsen psychosis and, in very unusual situations, cause patients to become violent. The nonpursued defense theory in Holmes’s case went something like the following:

  By the time he saw Dr. Fenton, Holmes had long-standing violent thoughts and wishes that were being kept in check by his ordinary impulse control, his anxiety, and his fear of the consequences of killing people. One effect of the sertraline, defense proponents said, was to reduce his anxiety and fear. That’s a desirable therapeutic result, but in his case, it freed his psyche to plan the killings and carry them out without fear of the consequences. One or two (so far as I know) defense consultants added the opinion that sertraline caused Holmes’s psychotic symptoms, including his human capital belief, thus creating a reason, albeit an irrational one, for him to kill others.

  The people who helped the defense develop these ideas, including a somewhat controversial British psychiatric consultant named David Healy, used a sometimes speculative case timeline to make their premise fit the facts. It relied in part on his undated notebook entries. They assumed that certain of Holmes’s thoughts arose just after he started taking the sertraline, that his self-diagnosed mental problems (such as “dysphoric mania”) were accurate, and that the purported adverse effects of the sertraline somehow not only persisted, but increased during the three to six weeks after he stopped the medication but before the shootings.