One in four American adults—roughly fifty-seven million people—experiences a mental health disorder every year, yet less than a third receive treatment. In 2000, a New York Times investigation looked at one hundred shooting rampages and found that at least half of the killers had signs of serious mental health problems. In 2001, Harvard Professor Ronald Kessler reported that most Americans with mental health disorders don’t seek help because of our national belief in “rugged individualism”—people want to “to solve the problem on their own.” For young adults, the reality is even more challenging. The National Institutes of Medical Health estimates that 8 percent of eighteen- to twenty-four-year-olds have a serious mental illness. Some experts have concluded that their best chance of getting adequate treatment comes from being arrested and incarcerated.
The issue of criminal insanity would emerge as the core question in the case of James Holmes. The Colorado “Insanity Law” reads:
1. The applicable test of insanity shall be, and the jury shall be so instructed: “A person who is so diseased or defective in mind at the time of the commission of the act as to be incapable of distinguishing right from wrong with respect to that act is not accountable. But care should be taken not to confuse such mental disease or defect with moral obliquity, mental depravity, or passion growing out of anger, revenge, hatred, or other motives, and kindred evil conditions, for when the act is induced by any of these causes the person is accountable to the law.”
2. The term “diseased or defective in mind,” as used in subsection (1) of this section, does not refer to an abnormality manifested only by repeated criminal or otherwise antisocial conduct.”
In Colorado, the state has the burden of proving that a defendant is sane. (In numerous other states, the burden is on the defense to prove that the accused is insane.) Also in Colorado, a defendant could ask for a mental health evaluation, and those examining him would be chosen by officials at the Colorado Mental Health Institute at Pueblo. Prosecutors did not have the right to select their own mental health examiners for a defendant, a sore spot in many DAs’ offices around the state—which would become even more so as Holmes’s case unfolded.
Says Denver neurologist Mark Spitz, who’s treated many patients with varying degrees of mental illness: “Holmes was probably using the grad school experience to look at himself and his own mind and mental health disorders. Schizophrenia becomes much more evident in some people in their twenties. It can intensify as you get older and cause breaks with reality. This can lead to delusional thinking, with people setting up thought processes that aren’t connected to reality, yet they believe in them. They can also have auditory hallucinations—hearing things that aren’t there. These people can be highly intelligent and can appear to be quite normal, but they live in other worlds and they’re fearful of things that don’t exist.
“Most people with these symptoms are not as high functioning and organized as James Holmes was and they’re obviously not in PhD programs. As a neurologist, the social issues around insanity trouble me because I’m very aware of the way the brain and brain diseases work and how they can cause behaviors that society believes are criminal. I’ve seen people with Alzheimer’s become highly disinhibited and do violent things because of the disease. How do we handle that as a culture? Is this criminal behavior or mental illness?
“I see a lot of patients with psychiatric problems who go into talk therapy, as Holmes did, but in my opinion this isn’t a very effective treatment. It often doesn’t help them understand themselves better or help them cope. Hindsight is 20/20 when looking at people who actually do harmful things. Over the years, I’ve been threatened by many patients, but I’ve only been physically attacked on one occasion. It’s very difficult to know when you need to commit someone to an institution or to have them held by the authorities.
“In the Holmes case, the question of sanity or insanity comes down to him knowing the difference between right and wrong at the time of the crime. In my view, based upon what I’ve observed about him from a distance, Holmes is delusional. That’s the key thing. He has no motive for doing what he did—none whatsoever. Talk to psychotic people and you’ll find no motive for the things they do. We try to apply rational thinking to them and it doesn’t work. I’ve learned to accept that they just have a broken brain.
“To me, it’s surprising that these mass shootings don’t happen more often. I see a lot of people who are psychotic and have homicidal thoughts, but they don’t carry them out. Holmes had the intelligence and the organization to follow through. Drinking and taking drugs, especially in combination, can also help cause people to do these things. They self-medicate excessively or they’re bipolar, but they don’t take their prescribed drugs because they don’t like them—the side effects can dull them out. To be in a manic state can be very pleasurable because it makes people feel creative and smart. With schizophrenia you tend to be in neutral more of the time. That’s why it’s much harder to pick out someone with this illness.”
Just after midnight on July 20, 2012, Holmes set in motion some of the most disturbing questions a society can face. What is criminal insanity? Is it a fixed mental condition or is it, as psychiatrists like to say, “state-dependent?” Are you only insane from time to time and under certain circumstances? The rest of the time you could be sane and relatively normal. What is the liability of psychiatrists and/or universities when they fail to identify and stop a murderous patient and student? Who deserves the death penalty? What impact do violent video games, violent movies, and America’s culture of violence, with its eleven-thousand-plus gun murders a year, have on young males?
What are the lasting effects of being bullied, especially in the first years of entering school? What are the long-term consequences of the parent/child relationship, when that connection seems at best tenuous and at worst broken as the child enters maturity and leaves home? Does neuroscience have anything of significance to tell us about what we call “evil” or the criminal mind?